探討心臟手術病患術前焦慮、樂觀、疼痛災難化與急性術後疼痛之關係

心臟手術可以協助心臟疾病患者改善心臟功能，但急性術後疼痛往往對癒後有負面影響。雖然目前鎮痛藥的使用已非常普遍，但疼痛緩解效果依然有限，因此根據疼痛多面向特性，心理因素的影響力也不容小覷。本研究目的為探討心臟手術病患術前焦慮、樂觀與疼痛災難化與急性術後疼痛的情形與關係，更深入討論疼痛災難化的中介效果。本研究為橫斷性相關性研究，於南部某醫學中心以便利取樣，納入100位接受傳統心臟手術(採胸骨正中切開法)的病患，以問卷調查法收集資料，利用SPSS 20.0統計軟體與中介效果檢驗法分析變項間的關係。研究結果如下：心臟手術病患術前為輕度焦慮、中度樂觀、中度疼痛災難化與中度急性術後疼痛；性別在急性術後疼痛的分數上有顯著差異；術前焦慮、樂觀與疼痛災難化對急性術後疼痛有顯著預測力，而且術前疼痛災難化在術前樂觀、焦慮與急性術後疼痛之間有統計上的完全中介的效果。依據本研究結果，我們建議：術前準備除了生理層面外，心理層面的調適，特別是疼痛災難化，也是重點之一。若能有效減低疼痛災難化的程度，將提升術後疼痛管理的成效與品質，對病患健康帶來正面的影響。

關鍵字

心臟手術；焦慮；樂觀；疼痛災難化；急性術後疼痛

並列摘要

Cardiac surgery is a surgical procedure that helps improve heart function, and acute pain is an expected problem after surgery. Untreated pain may cause complications and delay in the healing process. Although analgesics are commonly used after surgery, acute postoperative pain is not completely relieved. Pain is a multidimensional phenomenon. Accordingly, pain may relate to psychological factors. The aim of this study was to investigate the relationship between preoperative anxiety, optimism, pain catastrophizing and acute postoperative pain in patients undergoing cardiac surgery. Furthermore, the mediating role of pain catastrophizing was also examined. This cross-sectional study was performed on 100 patients undergoing cardiac surgery via median sternotomy in a medical center in southern Taiwan. State-Trait Anxiety Inventory-State, Life Orientation Test- Revised, Pain Catastrophizing Scale and Numeric Rating Scales were used to collect data. The data were analyzed using SPSS 20.0. The results showed that patients presented mild anxiety, moderate optimism, moderate pain catastrophizing before cardiac surgery, and they experienced moderate acute postoperative pain. Gender differences were found in acute postoperative pain. Preoperative anxiety, optimism, pain catastrophizing significantly predicted acute postoperative pain. Furthermore, preoperative pain catastrophizing fully mediated the relationship between preoperative anxiety and postoperative pain, and also the relationship between preoperative optimism and postoperative pain. According to the results, psychological preparation before surgery is important, especially pain catastrophizing. Reducing pain catastrophizing levels would be effective in decreasing acute postoperative pain and improving the quality of pain management.