憂鬱與焦慮對下背痛手術病人疼痛與生活品質之影響

背景：下背痛（low back pain, LBP）症狀為國民重要健康議題，全世界約有80%人口陳述曾經歷背痛困擾。手術治療為一有效介入，術後疼痛可明顯減緩且可維持三個月至兩年短期成效。臨床上估計約有15% 病人術後仍有持續或再發的背痛問題，並顯著損害生活及日常功能。心理情緒因子尤為一重要危險因子，本研究短期追蹤腰痛者手術後三個月，探究術前與術後一星期之心理情緒因子對手術預後之影響。方法：以南部某教學醫院神經外科下背痛手術病患50名，於術前填寫個人基本資料，並以貝克憂鬱量表 (BDI-II）評估憂鬱症狀、以狀態焦慮量表(STAI-S）評估情境焦慮感受、以視覺類比量表(VAS）評估疼痛感受及以生活品質量表(SF-36)評估生理及心理健康，且分別於術後一星期及三個月各施測相同之問卷。結果：術前狀態焦慮為術後三個月疼痛強度顯著預測變項；術後一星期憂鬱症狀為術後一星期情境焦慮與術後三個月疼痛完全中介變項；術後一星期憂鬱症狀為術後一星期情境焦慮與術後三個月心理健康生活品質完全中介變項；術後一星期情境焦慮為術後一星期憂鬱症狀與術後三個月生理健康生活品質部分中介變項。討論：術前焦慮情緒顯著影響術後三個月疼痛、術後一星期憂鬱症狀顯著影響術後三個月疼痛；術後一星期憂鬱症狀顯著影響術後三個月心理健康、術後一星期焦慮情緒顯著影響術後三個月生理健康。因此建議應於術前及病患出院前皆評估其憂鬱症狀及焦慮狀態，即可早期衛教與治療介入，預防並減少預後不佳發生可能性。

關鍵字

憂鬱症狀；狀態焦慮；下背痛；疼痛；心理健康；生理健康；生活品質

並列摘要

Background: The symptom of low back pain is an important health issue: about 80% of persons worldwide complian about low back pain once in their lives. Surgery is an effective intervention; the pain is significantly alleviated after the surgery, and maintained for a short period of three months to two years. Clinically, an estimate of 15% of the patients continues to feel the pain or relapse after the surgery and this pain significantly disrupts life and daily function. Psychological emotion is an especially important factor. This study aims to follow up a short term of three months after surgery and investigates the effect of psychological emotional factor prior to and one week after the surgery on the prognosis of the surgery. Methods: Fifty patients with low back pain recruited from the neurological department in a teaching hospital in southern Taiwan filled out demographic information, Beck Depression Inventory II (BDI-II） to assess depressive symptoms, State Anxiety Inventory (STAI-S）to assess situational anxiety feelings, Visual Analogue Scale（VAS） to assess pain and Short Form Health Survey 36 (SF-36) to assess physical and mental health. The same inventories were completed a week and three months after the surgery. Results: The state anxiety prior to surgery can predict the pain three months after the surgery; The depressive symptoms a week after the surgery full mediator the relationship between the state anxiety a week after the surgery and the pain three months after the surgery;The depressive symptoms a week after the surgery full mediator the relationship between the state anxiety a week after the surgery and the quality of life in mental component summary three months after the surgery; The state anxiety a week after the surgery partial mediator the relationship between depressive symptoms a week after the surgery and the quality of life in physical component summary three months after the surgery. Discussion：Situational anxiety before the surgery has significant effect on the pain three months after the surgery, depressive symptoms a week after the surgery has significant effect on the pain three months after the surgery, depressive symptoms a week after the surgery has significant effect on the quality of life in mental component summary three months after the surgery, state anxiety a week after the surgery has significant effect on the quality of life in physical component summary three months after the surgery. Therefore, the results suggest depressive symptoms and state anxiety be assessed prior the surgery and discharged from the hospital to provide psychoeducation and intervention to achieve the best prognosis.