帕罗西汀对老年骨折伴焦虑抑郁患者术后心理状态及疼痛介质的影响

摘要

Objective To investigate the effect of paroxetine on psychological status,pain score and pain mediators after surgery in the elderly patients with anxiety and depression after fracture.Methods From April 2015 to December 2016,a total of 60 eldly patients with anxiety and depression after fracture were enrolled in the study.According to the sequence of hospital admissions,all patients were divided into two groups:treatment group (n=30) and control group (n=30).All patients were given the conventional therapy and nursing.The treatment group recevied paroxetine on the basis of control group.Hamilton Anxiety Scale (HAMA),Hamilton Depression Scale (HAMD) were used to evaluate mood disorders change.Visual Analogue Scale (VAS) was applied to measure pain.The levels of 5-hydroxytryptamine (5-HT),nitric oxide (NO) and prostaglandin E2 (PGE2) were determined by enzyme linked immunosorbent assay (ELISA).The changes of psychological state,pain scale and serum pain mediators before and 28 d after treatment were observed and compared in both groups.Nursing satisfaction level was evaluated before discharging.Results Before treatment,there were no statistical difference in HAMA,HAMD and VAS score between two groups (P ＞0.05).After treatment,HAMA,HAMD and VAS score in the two groups were significantly lower than before treatment (all P ＜0.01).After treatment,HAMA,HAMD and VAS score in the treatment group were significantly lower than those in control group,respectively (P ＜0.05 or 0.01).Before treatment,there were no statistical differences in serum 5-HT,NO,PGE2 levels between two groups (P＞0.05).After treatment,serum 5-HT,NO,PGE2 levels in both groups were significantly lower than before treatment (all P＜0.01).After treatment,serum 5-HT,NO,PGE2 levels in the treatment group were significantly lower than those in control group,respectively (P ＜0.05 or 0.01).Satisfaction on nursing service in the treatment group was higher than that in control group (P ＜0.05).Conclusion Paroxetine can effectively relieve anxiety and depression,reduce pain and the expression of pain mediators,improve nursing satisfaction.%目的 探讨帕罗西汀对老年骨折伴焦虑抑郁患者术后心理状态、疼痛程度评分及疼痛介质的影响.方法 选择2015年4月-2016年12月老年骨折伴抑郁焦虑术后患者60例,根据入院顺序分为治疗组(n=30)和对照组(n=30).两组患者均予以骨科常规治疗及护理,治疗组在此基础上加用帕罗西汀.采用汉密尔顿焦虑、抑郁量表(HAMA、HAMD)评估抑郁焦虑症状,采用视觉模拟评分(VAS)评估疼痛程度,采用酶联免疫吸附法(ELISA)检测血清疼痛介质5-羟色胺(5-HT)、一氧化氮(NO)、前列腺素E2 (PGE2)水平.观察并比较两组患者治疗前、治疗28天后心理状态、疼痛评分及血清疼痛介质的变化.患者出院前行护理满意度评价.结果 两组患者治疗前HAMA、HAMD、VAS评分比较,差异无统计学意义(P＞0.05),治疗后治疗组HAMA、HAMD、VAS评分均明显低于治疗前(均P＜0.01),治疗后治疗组HAMA、HAMD、VAS评分明显低于对照组(P＜0.05或0.01);治疗前两组血清疼痛介质5-HT、NO、PGE2水平比较,差异无统计学意义(P＞0.05),治疗后两组患者血清5-HT、NO、PGE2水平均明显下降(均P＜0.01),治疗后治疗组血清疼痛介质5-HT、NO、PGE2水平明显低于对照组(P＜0.05或0.01);治疗组护理满意度明显高于对照组(P＜0.05).结论 帕罗西汀有效缓解了老年患者骨折术后抑郁焦虑情绪,降低了疼痛程度及血清疼痛介质水平,提高了患者的护理满意度.