外科术后疲劳相关因素初探
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摘要
研究背景
“术后疲劳”(Postoperative Fatigue, POF)是指患者在手术后的一段时间内出现的乏力、失眠、注意力不集中、抑郁、紧张、焦虑等一系列证候群。常以疲惫不堪、虚弱无力或者萎靡不振一类的感觉出现作为症状,亦可表现为负面情绪。大量研究发现POF主要出现在术后1月内,有部分患者持续更长时间。POF发病率高,几乎所有大手术的患者均出现疲劳。
POF病因尚不明确,现代医学目前认为是生理性因素、心理性因素和社会因素综合作用。国内传统医学认为疲劳属于“虚”、“虚劳”、“虚损”等范畴,概括其病因为外感与内伤,病机为病因长期作用导致脏腑气血阴阳亏损,病性主要为虚,病位在五脏,理论研究认为责于肝脾,临床研究证实脾胃虚弱是重要病机,但肝与POF未显示出有明确的直接关系。
目前生理指标用于POF的观察比较而不作为诊断标准使用,研究者多利用心理学调查量表或问卷对POF进行评测。
受制于病因研究进展,仍缺乏普遍的有效的治疗方法,疗效研究主要集中在：营养支持、激素治疗、心理治疗、传统医学治疗。
研究目的
本课题尝试利用量表收集了解接受手术的患者的POF状况,对ICFS中文版测量属性作初步评估,探讨在手术干预下,影响POF的相关因素,分析不同阶段的生理性与心理性因素作用,为同属于中医的“虚劳”范畴的术后疲劳与其他疲劳综合征的比较提供新的切入点,以期为进一步深入研究积累经验并为中西医结合诊治POF提供参考。
研究对象与方法
从2008-2009年间在广州中医药大学第二附属医院(广东省中医院)外一、外二、外三、肛肠科住院部接受手术患者中确定符合纳入标准的160例患者。应用VAS、BPOMS、ICFS、CRF量表采集记录。
采用Epidata 3.1建立调查表数据库,双录双输所有数据；统计过程在SPSS16.0统计软件包中进行。统计方法包括描述性统计、正态性及方差齐的假设检验、两相关样本多重比较Wilcoxon法(检验水准经校正)、直线相关性分析,检验水准除特殊说明外取α=0.05,采用双侧检验。对ICFS汉化版在国内的应用进行信效度评价。
研究结果
1、POF发病率高,术后第3天67.5%患者出现POF,在术后1个月仍有25%的发病率。以中老年患者为主(47岁以后组段共占67.6%)；
2、VAS值术后较术前升高,然后随时间推移有所下降。和术前比较,VAS值术后的升高具有统计学意义；术后第3天VAS值达到顶点,术后第14天VAS值亦有升高,提示术后POF在恢复期中近期疲劳较明显。
3、BPOMS值术前及术后总体处于负性心境状态,术后第3天BPOMS值最高,术后BPOMS值随时间推移逐渐下降。和术前比较,术后第30天BPOMS值与术前水平相当,术后各时点BPOMS值的下降具有统计学意义。
4、ICFS值为负值,总体显示精力较好,分值术后较术前升高,疲劳度有所升高。和术前比较,术后第14、30天ICFS值的升高具有统计学意义。
5、术前疲劳程度与术后POF呈正相关,术前疲劳越重,术后疲劳值亦越重(P＜0.05)。年龄因素对术后第3天POF的发生呈正相关,年龄越高,疲劳值越高(P＜0.05)。文化程度与术后早期POF负相关,在术后早期,文化程度高,疲劳程度较低(P值＜0.05)。对手术费用的担忧影响了术后第3天的POF,越担忧该时点疲劳越明显(P值＜0.05)。性别、婚姻状况、职业类型、付费方式与术后时点无相关关系。
6、术后第3天疲劳程度越高,术后住院天数越长(P值＜0.01)。手术部位对术后第7天疲劳有影响(P＜0.01)。手术类型与术后第7天的疲劳正相关(P＜0.05)。手术时间对术后第3天疲劳有影响,手术时间越长,术后第3天疲劳度越高(P＜0.05)。术后留置镇痛泵的患者术后第3天的疲劳评分要高(P＜0.05)。术后留置术口引流管和导尿管与术后第3天疲劳程度正相关,留置术口引流管或导尿管可能导致POF(P＜0.05)。肠外营养的患者其术后第3天疲劳评分正相关(P＜0.05)。疾病性质、手术方式、术中出血量、麻醉方式、鼻胃管留置与术后POF无相关关系。
7、血氯与术后第3天疲劳程度正相关(P＜0.05)。总胆红素与术后第7、14天疲劳程度正相关(P＜0.05)。肌酐与术后第14天的POF有正相关(P＜0.05)。血常规主要指标与POF无相关关系。
8、相同时点BPOMS值与该时点VAS值正相关,该时点的心境评估得分越高,疲劳程度越高(P＜0.05)。术前BPOMS值与术后时点VAS值正相关,术前心境评估得分越高,术后疲劳程度越高(P＜0.05)。术前VAS值与术后时点BPOMS值正相关,术前疲劳程度越高,术后心境评估得分越高(P＜0.05)。
9、ICFS信效度的初步评价显示整体Cronbach Alpha=0.733,初步显示总体较为合理,疲劳和活力维度信度较好,但注意力维度内部一致性信度过低(标化Cronbach Alpha=0.383),精力、日常活动度维度内条目需重新评估；主成分和因子分析显示,三个主成分Z1、Z2、Z4的载荷因子旋转前后比较稳定,经旋转后的因子更集中,而另外四个主成分Z3、Z5、Z6、Z7则变化较大。对于ICFS量表的条目需要作出调整,重新验证。VAS值对同时点的ICFS进为正相关。
研究结论
1、术后疲劳发病率高,在各种手术中均可出现,持续时间长,以中老年为主。
2、年龄、对费用的担忧、手术部位、手术类型、手术时间、术口引流管和导尿管留置、术前血氯浓度、术前血总胆红素浓度、术前血肌酐浓度与POF正相关。文化程度、术后营养状况、镇痛泵留置与POF负相关。对中老年龄段、对费用比较担忧、文化程度低、拟行限期或急诊手术、术前血总胆红素浓度或术前血肌酐浓度高、手术时间长、术后留置引流管或术后肠外营养为主的患者,POF情况可能较重,积极应对有助于缓解POF症状。
3、术后康复期早期疲劳程度高的术后住院天数增加,改善POF对减轻患者和社会卫生支出有切实的意义。
4、POF与术后心境状态密切关联,互相影响,心理因素对POF的影响贯穿整个术后康复期。生理性因素对术后康复期早期POF有重要影响。POF是生理性因素与心理性因素是联合作用于机体的连续性过程。
5、手术有应在传统医学理论体系中确立其地位。在围手术期重视心理性因素的监测,保证积极的心理干预措施贯穿围手术期治疗始终；针对术前及术后康复早中期对POF生理性因素进行检测,根据其作用机制采取相应治疗措施。
6、ICFS信效度的初步评价显示信度初步显示总体较为合理,疲劳和活力维度信度较好,对于ICFS量表的条目需要作出调整,重新验证。
Background
Postoperative fatigue (POF) is that a series of syndromes, such as debility, insomnia, inattention, depression, stress, anxiety, have appeared in postoperative patients. Patients usually feel exhausted, weakness or malaise appears as a class of symptoms, also showe negative emotions. Numerous studies studies found that POF occurred mainly within 1 month after a surgical operation, even lasted much longer.. POF with a high incidence and tortur almost all major surgery patients.
POF etiology is not clear, modern medicine now considered to be physiological factors, psychological factors and social factors.Domestic traditional medicine that the fatigue is "false", "consumptive", "wasting" and other aspects of their disease because of exogenous and general internal injury, for the cause of long-term role in pathogenesis lead to loss of blood and viscera of yin and yang, is mainly for the virtual patient, diseaselocated in the five internal organs, liver and spleen theory that responsibility in the clinical study has confirmed the spleen and stomach are important in pathogenesis of liver and POF, but did not show a clear direct relationship.
Physiological indicators of the current observation and comparison for the POF as the diagnostic standard without the use of survey researchers make more use of psychological scales or questionnaires on POF for evaluation. Subject to the cause of progress, is still a lack of universal and effective methods of treatment efficacy research focuses on:nutrition, hormone therapy, psychological therapy, traditional medicine.
Objectives
The subject tried to use the scale to collect about POF patients for surgery situation, the Chinese version of the ICFS measurement attribute for a preliminary assessment of the surgical intervention, the impact of POF related factors, analysis of different stages of physiological function and psychological factors,To belong to Chinese medicine, "consumptive" category after fatigue compared with other fatigue syndrome to provide a new starting point, in order to accumulate experience for further in-depth study of Traditional Chinese treatment for POF reference.
Methods
From 2008 to 2009 in Hospital of Guangdong Province and outside the outer two, three external, Anorectal inpatient surgery patients met the inclusion criteria identified 160 patients. Application of VAS, BPOMS, ICFS, CRF scale collection records.
The establishment of the questionnaire used Epidata 3.1 database, double-lose-lose all the data recorded; statistical process carried out in SPSS16.0 statistical package. Statistical methods included descriptive statistics, normality and homogeneity of variance hypothesis testing, multiple comparisons of two related samples Wilcoxon method (test level by the correction), linear correlation analysis, testing standards except in special indicated takeα=0.05 (2-tailed test). Chinese Version of the ICFS application in the domestic assessment of reliability and validity.
Results
1. POF with a high incidence,67.5% 3 days after surgery patients POF,1 month after surgery the incidence is still 25%. Mainly to middle-aged patients (Over 47 years old the group segment accounted for 67.6%);
2. VAS values increased after surgery than before surgery, and then decline over time. And preoperative, VAS values were statistically significant higher postoperative; VAS values after 3 days peaked at 14 days also increased VAS values, suggesting that POF in the recovery period after fatigue more pronounced in recent.
3. BPOMS values before and after operation in a negative mood state in general, after the first 3 days BPOMS value of the highest value after BPOMS gradually decreased with time. And preoperative and postoperative value of 30 days BPOMS same level with the preoperative and postoperative values at each time point BPOMS statistically significant decline.
4. ICFS value is negative, the overall show that energy is better than the preoperative scores of patients increased, fatigue was increased. And preoperative, postoperative value of 14.30 days ICFS statistically significant increase.
5. Preoperative and postoperative fatigue was positively correlated with POF, the more severe preoperative fatigue, fatigue after the value has more weight (P<0.05). Of age on postoperative day 3 was positively correlated with the occurrence of POF, the higher the age, the higher the fatigue value (P <0.05). Education negative correlation between early POF, the early postoperative period, higher education, less fatigue (P value<0.05). Concerns about the cost of the surgery affected after 3 days of POF, the more worried the more obvious the point of fatigue (P value<0.05). Sex, marital status, occupation type, mode and no correlation between postoperative time point.
6. Preoperative and postoperative fatigue was positively correlated with POF, the more severe preoperative fatigue, fatigue after the value has more weight (P<0.05). Of age on postoperative day 3 was positively correlated with the occurrence of POF, the higher the age, the higher the fatigue value (P <0.05). Education negative correlation between early POF, the early postoperative period, higher education, less fatigue (P value<0.05). Concerns about the cost of the surgery affected after 3 days of POF, the more worried the more obvious the point of fatigue (P value<0.05). Sex, marital status, occupation type, mode and no correlation between postoperative time point.
7. Blood chloride and 3 days after surgery is related to the degree of fatigue (P<0.05). Total bilirubin and 7,14 days after surgery is related to the degree of fatigue (P<0.05). Creatinine and 14 days after operation, POF has a positive correlation (P<0.05). Blood target and no correlation between POF.
8. Value and the same time points BPOMS point VAS values are related to the timing of mood assessment scores higher, the higher the degree of fatigue (P<0.05). BPOMS value of preoperative and postoperative time point VAS values are related to the preoperative evaluation of mind score higher, the higher the degree of fatigue after surgery (P<0.05). VAS value of preoperative and postoperative time point BPOMS value is related to the higher preoperative fatigue and postoperative evaluation of mind score higher (P<0.05).
9. ICFS reliability and validity of the preliminary evaluation shows that the overall Cronbach Alpha=0.733, initial signs generally more reasonable, fatigue and vitality dimensions of reliability is better, but the attention dimension through the low internal consistency (standardized Cronbach Alpha =0.383), energy, daily activity within the entry to be re-assessed dimensions; principal component and factor analysis showed that three principal components Z1, Z2, Z4's load factor is relatively stable before and after rotation by the revolving factor is more concentrated, while the otherfour principal components Z3, Z5, Z6, Z7 is changed greatly. Scale of entry for the ICFS need to make adjustments, re-verification. VAS value on the same point ICFS into a positive relationship.
Conclusions
1.High incidence of postoperative fatigue, can occur in a variety of surgery, long duration, in order to mainly middle-aged.
2. Age, the cost concerns, surgical site, type of surgery, operative time, intraoperative and catheter drainage tube mouth, preoperative serum chloride concentration, preoperative serum total bilirubin concentration, preoperative serum creatinine levels correlated with the POF. Education, nutritional status after surgery, analgesia pump retaining a negative correlation with the POF. On in old age, more worried about the cost, low educational level, scheduled for the deadline or emergency surgery, preoperative serum total bilirubin concentration or high preoperative serum creatinine concentration, longer operation time, postoperative indwelling drainage tube or afterpatients with parenteral nutrition-based, POF may be heavier, positively respond to help relieve symptoms of POF.
3. Early postoperative rehabilitation after fatigue with a high degree of postoperative hospital stay increased to improve the POF patients and the community to alleviate health spending has practical significance.
4.POF is closely associated with postoperative mood, affect each other, the impact of psychological factors on POF throughout the postoperative rehabilitation period. Physiological factors on the postoperative rehabilitation have a major impact on the early POF. POF is the physiological factors and psychological factors are the continuity of the joint process of acting on the body.
5. Surgery has the theoretical system of traditional medicine should be established in their place. In the peri-operative monitoring of attention to psychological factors, to ensure a positive psychological interventions throughout the perioperative treatment has always been; for preoperative and postoperative rehabilitation of POF as early as mid to detect physiological factors, according to its mechanism of action to take corresponding treatment.
6. ICFS reliability and validity of the preliminary evaluation shows that the overall reliability of the initial display is more reasonable reliability of fatigue and vitality dimensions of good entries for the ICFS scale needs to be adjusted, re-verification.
“术后疲劳”(Postoperative Fatigue, POF)是指患者在手术后的一段时间内出现的乏力、失眠、注意力不集中、抑郁、紧张、焦虑等一系列证候群。常以疲惫不堪、虚弱无力或者萎靡不振一类的感觉出现作为症状,亦可表现为负面情绪。大量研究发现POF主要出现在术后1月内,有部分患者持续更长时间。POF发病率高,几乎所有大手术的患者均出现疲劳。
POF病因尚不明确,现代医学目前认为是生理性因素、心理性因素和社会因素综合作用。国内传统医学认为疲劳属于“虚”、“虚劳”、“虚损”等范畴,概括其病因为外感与内伤,病机为病因长期作用导致脏腑气血阴阳亏损,病性主要为虚,病位在五脏,理论研究认为责于肝脾,临床研究证实脾胃虚弱是重要病机,但肝与POF未显示出有明确的直接关系。
目前生理指标用于POF的观察比较而不作为诊断标准使用,研究者多利用心理学调查量表或问卷对POF进行评测。
受制于病因研究进展,仍缺乏普遍的有效的治疗方法,疗效研究主要集中在：营养支持、激素治疗、心理治疗、传统医学治疗。
研究目的
本课题尝试利用量表收集了解接受手术的患者的POF状况,对ICFS中文版测量属性作初步评估,探讨在手术干预下,影响POF的相关因素,分析不同阶段的生理性与心理性因素作用,为同属于中医的“虚劳”范畴的术后疲劳与其他疲劳综合征的比较提供新的切入点,以期为进一步深入研究积累经验并为中西医结合诊治POF提供参考。
研究对象与方法
从2008-2009年间在广州中医药大学第二附属医院(广东省中医院)外一、外二、外三、肛肠科住院部接受手术患者中确定符合纳入标准的160例患者。应用VAS、BPOMS、ICFS、CRF量表采集记录。
采用Epidata 3.1建立调查表数据库,双录双输所有数据；统计过程在SPSS16.0统计软件包中进行。统计方法包括描述性统计、正态性及方差齐的假设检验、两相关样本多重比较Wilcoxon法(检验水准经校正)、直线相关性分析,检验水准除特殊说明外取α=0.05,采用双侧检验。对ICFS汉化版在国内的应用进行信效度评价。
研究结果
1、POF发病率高,术后第3天67.5%患者出现POF,在术后1个月仍有25%的发病率。以中老年患者为主(47岁以后组段共占67.6%)；
2、VAS值术后较术前升高,然后随时间推移有所下降。和术前比较,VAS值术后的升高具有统计学意义；术后第3天VAS值达到顶点,术后第14天VAS值亦有升高,提示术后POF在恢复期中近期疲劳较明显。
3、BPOMS值术前及术后总体处于负性心境状态,术后第3天BPOMS值最高,术后BPOMS值随时间推移逐渐下降。和术前比较,术后第30天BPOMS值与术前水平相当,术后各时点BPOMS值的下降具有统计学意义。
4、ICFS值为负值,总体显示精力较好,分值术后较术前升高,疲劳度有所升高。和术前比较,术后第14、30天ICFS值的升高具有统计学意义。
5、术前疲劳程度与术后POF呈正相关,术前疲劳越重,术后疲劳值亦越重(P＜0.05)。年龄因素对术后第3天POF的发生呈正相关,年龄越高,疲劳值越高(P＜0.05)。文化程度与术后早期POF负相关,在术后早期,文化程度高,疲劳程度较低(P值＜0.05)。对手术费用的担忧影响了术后第3天的POF,越担忧该时点疲劳越明显(P值＜0.05)。性别、婚姻状况、职业类型、付费方式与术后时点无相关关系。
6、术后第3天疲劳程度越高,术后住院天数越长(P值＜0.01)。手术部位对术后第7天疲劳有影响(P＜0.01)。手术类型与术后第7天的疲劳正相关(P＜0.05)。手术时间对术后第3天疲劳有影响,手术时间越长,术后第3天疲劳度越高(P＜0.05)。术后留置镇痛泵的患者术后第3天的疲劳评分要高(P＜0.05)。术后留置术口引流管和导尿管与术后第3天疲劳程度正相关,留置术口引流管或导尿管可能导致POF(P＜0.05)。肠外营养的患者其术后第3天疲劳评分正相关(P＜0.05)。疾病性质、手术方式、术中出血量、麻醉方式、鼻胃管留置与术后POF无相关关系。
7、血氯与术后第3天疲劳程度正相关(P＜0.05)。总胆红素与术后第7、14天疲劳程度正相关(P＜0.05)。肌酐与术后第14天的POF有正相关(P＜0.05)。血常规主要指标与POF无相关关系。
8、相同时点BPOMS值与该时点VAS值正相关,该时点的心境评估得分越高,疲劳程度越高(P＜0.05)。术前BPOMS值与术后时点VAS值正相关,术前心境评估得分越高,术后疲劳程度越高(P＜0.05)。术前VAS值与术后时点BPOMS值正相关,术前疲劳程度越高,术后心境评估得分越高(P＜0.05)。
9、ICFS信效度的初步评价显示整体Cronbach Alpha=0.733,初步显示总体较为合理,疲劳和活力维度信度较好,但注意力维度内部一致性信度过低(标化Cronbach Alpha=0.383),精力、日常活动度维度内条目需重新评估；主成分和因子分析显示,三个主成分Z1、Z2、Z4的载荷因子旋转前后比较稳定,经旋转后的因子更集中,而另外四个主成分Z3、Z5、Z6、Z7则变化较大。对于ICFS量表的条目需要作出调整,重新验证。VAS值对同时点的ICFS进为正相关。
研究结论
1、术后疲劳发病率高,在各种手术中均可出现,持续时间长,以中老年为主。
2、年龄、对费用的担忧、手术部位、手术类型、手术时间、术口引流管和导尿管留置、术前血氯浓度、术前血总胆红素浓度、术前血肌酐浓度与POF正相关。文化程度、术后营养状况、镇痛泵留置与POF负相关。对中老年龄段、对费用比较担忧、文化程度低、拟行限期或急诊手术、术前血总胆红素浓度或术前血肌酐浓度高、手术时间长、术后留置引流管或术后肠外营养为主的患者,POF情况可能较重,积极应对有助于缓解POF症状。
3、术后康复期早期疲劳程度高的术后住院天数增加,改善POF对减轻患者和社会卫生支出有切实的意义。
4、POF与术后心境状态密切关联,互相影响,心理因素对POF的影响贯穿整个术后康复期。生理性因素对术后康复期早期POF有重要影响。POF是生理性因素与心理性因素是联合作用于机体的连续性过程。
5、手术有应在传统医学理论体系中确立其地位。在围手术期重视心理性因素的监测,保证积极的心理干预措施贯穿围手术期治疗始终；针对术前及术后康复早中期对POF生理性因素进行检测,根据其作用机制采取相应治疗措施。
6、ICFS信效度的初步评价显示信度初步显示总体较为合理,疲劳和活力维度信度较好,对于ICFS量表的条目需要作出调整,重新验证。
Background
Postoperative fatigue (POF) is that a series of syndromes, such as debility, insomnia, inattention, depression, stress, anxiety, have appeared in postoperative patients. Patients usually feel exhausted, weakness or malaise appears as a class of symptoms, also showe negative emotions. Numerous studies studies found that POF occurred mainly within 1 month after a surgical operation, even lasted much longer.. POF with a high incidence and tortur almost all major surgery patients.
POF etiology is not clear, modern medicine now considered to be physiological factors, psychological factors and social factors.Domestic traditional medicine that the fatigue is "false", "consumptive", "wasting" and other aspects of their disease because of exogenous and general internal injury, for the cause of long-term role in pathogenesis lead to loss of blood and viscera of yin and yang, is mainly for the virtual patient, diseaselocated in the five internal organs, liver and spleen theory that responsibility in the clinical study has confirmed the spleen and stomach are important in pathogenesis of liver and POF, but did not show a clear direct relationship.
Physiological indicators of the current observation and comparison for the POF as the diagnostic standard without the use of survey researchers make more use of psychological scales or questionnaires on POF for evaluation. Subject to the cause of progress, is still a lack of universal and effective methods of treatment efficacy research focuses on:nutrition, hormone therapy, psychological therapy, traditional medicine.
Objectives
The subject tried to use the scale to collect about POF patients for surgery situation, the Chinese version of the ICFS measurement attribute for a preliminary assessment of the surgical intervention, the impact of POF related factors, analysis of different stages of physiological function and psychological factors,To belong to Chinese medicine, "consumptive" category after fatigue compared with other fatigue syndrome to provide a new starting point, in order to accumulate experience for further in-depth study of Traditional Chinese treatment for POF reference.
Methods
From 2008 to 2009 in Hospital of Guangdong Province and outside the outer two, three external, Anorectal inpatient surgery patients met the inclusion criteria identified 160 patients. Application of VAS, BPOMS, ICFS, CRF scale collection records.
The establishment of the questionnaire used Epidata 3.1 database, double-lose-lose all the data recorded; statistical process carried out in SPSS16.0 statistical package. Statistical methods included descriptive statistics, normality and homogeneity of variance hypothesis testing, multiple comparisons of two related samples Wilcoxon method (test level by the correction), linear correlation analysis, testing standards except in special indicated takeα=0.05 (2-tailed test). Chinese Version of the ICFS application in the domestic assessment of reliability and validity.
Results
1. POF with a high incidence,67.5% 3 days after surgery patients POF,1 month after surgery the incidence is still 25%. Mainly to middle-aged patients (Over 47 years old the group segment accounted for 67.6%);
2. VAS values increased after surgery than before surgery, and then decline over time. And preoperative, VAS values were statistically significant higher postoperative; VAS values after 3 days peaked at 14 days also increased VAS values, suggesting that POF in the recovery period after fatigue more pronounced in recent.
3. BPOMS values before and after operation in a negative mood state in general, after the first 3 days BPOMS value of the highest value after BPOMS gradually decreased with time. And preoperative and postoperative value of 30 days BPOMS same level with the preoperative and postoperative values at each time point BPOMS statistically significant decline.
4. ICFS value is negative, the overall show that energy is better than the preoperative scores of patients increased, fatigue was increased. And preoperative, postoperative value of 14.30 days ICFS statistically significant increase.
5. Preoperative and postoperative fatigue was positively correlated with POF, the more severe preoperative fatigue, fatigue after the value has more weight (P<0.05). Of age on postoperative day 3 was positively correlated with the occurrence of POF, the higher the age, the higher the fatigue value (P <0.05). Education negative correlation between early POF, the early postoperative period, higher education, less fatigue (P value<0.05). Concerns about the cost of the surgery affected after 3 days of POF, the more worried the more obvious the point of fatigue (P value<0.05). Sex, marital status, occupation type, mode and no correlation between postoperative time point.
6. Preoperative and postoperative fatigue was positively correlated with POF, the more severe preoperative fatigue, fatigue after the value has more weight (P<0.05). Of age on postoperative day 3 was positively correlated with the occurrence of POF, the higher the age, the higher the fatigue value (P <0.05). Education negative correlation between early POF, the early postoperative period, higher education, less fatigue (P value<0.05). Concerns about the cost of the surgery affected after 3 days of POF, the more worried the more obvious the point of fatigue (P value<0.05). Sex, marital status, occupation type, mode and no correlation between postoperative time point.
7. Blood chloride and 3 days after surgery is related to the degree of fatigue (P<0.05). Total bilirubin and 7,14 days after surgery is related to the degree of fatigue (P<0.05). Creatinine and 14 days after operation, POF has a positive correlation (P<0.05). Blood target and no correlation between POF.
8. Value and the same time points BPOMS point VAS values are related to the timing of mood assessment scores higher, the higher the degree of fatigue (P<0.05). BPOMS value of preoperative and postoperative time point VAS values are related to the preoperative evaluation of mind score higher, the higher the degree of fatigue after surgery (P<0.05). VAS value of preoperative and postoperative time point BPOMS value is related to the higher preoperative fatigue and postoperative evaluation of mind score higher (P<0.05).
9. ICFS reliability and validity of the preliminary evaluation shows that the overall Cronbach Alpha=0.733, initial signs generally more reasonable, fatigue and vitality dimensions of reliability is better, but the attention dimension through the low internal consistency (standardized Cronbach Alpha =0.383), energy, daily activity within the entry to be re-assessed dimensions; principal component and factor analysis showed that three principal components Z1, Z2, Z4's load factor is relatively stable before and after rotation by the revolving factor is more concentrated, while the otherfour principal components Z3, Z5, Z6, Z7 is changed greatly. Scale of entry for the ICFS need to make adjustments, re-verification. VAS value on the same point ICFS into a positive relationship.
Conclusions
1.High incidence of postoperative fatigue, can occur in a variety of surgery, long duration, in order to mainly middle-aged.
2. Age, the cost concerns, surgical site, type of surgery, operative time, intraoperative and catheter drainage tube mouth, preoperative serum chloride concentration, preoperative serum total bilirubin concentration, preoperative serum creatinine levels correlated with the POF. Education, nutritional status after surgery, analgesia pump retaining a negative correlation with the POF. On in old age, more worried about the cost, low educational level, scheduled for the deadline or emergency surgery, preoperative serum total bilirubin concentration or high preoperative serum creatinine concentration, longer operation time, postoperative indwelling drainage tube or afterpatients with parenteral nutrition-based, POF may be heavier, positively respond to help relieve symptoms of POF.
3. Early postoperative rehabilitation after fatigue with a high degree of postoperative hospital stay increased to improve the POF patients and the community to alleviate health spending has practical significance.
4.POF is closely associated with postoperative mood, affect each other, the impact of psychological factors on POF throughout the postoperative rehabilitation period. Physiological factors on the postoperative rehabilitation have a major impact on the early POF. POF is the physiological factors and psychological factors are the continuity of the joint process of acting on the body.
5. Surgery has the theoretical system of traditional medicine should be established in their place. In the peri-operative monitoring of attention to psychological factors, to ensure a positive psychological interventions throughout the perioperative treatment has always been; for preoperative and postoperative rehabilitation of POF as early as mid to detect physiological factors, according to its mechanism of action to take corresponding treatment.
6. ICFS reliability and validity of the preliminary evaluation shows that the overall reliability of the initial display is more reasonable reliability of fatigue and vitality dimensions of good entries for the ICFS scale needs to be adjusted, re-verification.
引文
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