摘 要
目的：
1.调查新疆石河子市神经病理性疼痛老年人的生活质量状况，分析影响神经病理性疼痛老年人生活质量的因素，为改善神经病理性疼痛老年人生活质量提供指导。
2.了解新疆石河子市神经病理性疼痛老年人的患病状况，为治疗疾病提供依据。
方法：
1.本次研究采用便利抽样，抽取 2016 年 1 月～2017 年 12 月在新疆石河子市两家医院（石河子市人民医院、石河子大学医学院第一附属医院）就诊的 60 岁以上，符合纳入、排除标准的神经病理性疼痛老年人共 248 例为研究对象，进行问卷调查，包括患者一般资料，BMI 体质指数，生活质量调查，疼痛程度评估，病因调查。
2.所有数据采用 EpiData3.0 建立数据库，运用 SPSS19.0 统计学软件进行分析。表格运用 EXCEL 进行绘制；计数资料采用例数和构成比进行描述；计量资料采用“ x ± s”
表示；单因素分析采用独立样本 t 检验、方差分析、Pearson 相关分析；多因素分析采用多重线性回归分析，P＜0.05 表示差异有统计学意义。
结果：
1.本次调查共发放问卷 262 份，回收有效问卷 248 份，回收有效率为 94.66%。
2.根据VAS视觉模拟评分结果，轻度疼痛47例（18.95%），中度疼痛126例（50.81%），重度疼痛 75 例（30.24%），所有老年患者平均分为 5.85±3.19 分。
3.248 例老年患者中原发性 NP137 例（55.24%），继发性 NP 111 例（44.76%）。
按照疼痛部位中枢性神经痛占 8.06%，周围性神经痛 91.94%。本研究前五位疾病种类是三叉神经痛（32.66%）、神经根痛（14.52%）、癌症相关疼痛（14.11%）、舌咽神经痛（8.06%）、带状疱疹后遗神经痛（7.26%）。
4.本研究运用SF-36生活质量量表对石河子市两家医院就诊的神经病理性疼痛老年人进行横断面调查，总得分 55.45±16.72 分。
5.单因素分析表明男性与女性生活质量差异无统计学意义(P＞0.05)；居住于农村与城市的患者生活质量差异无统计学意义(P＞0.05)；正常、消瘦、超重和肥胖患者生活质量总分均值差异无统计学意义(P＞0.05)；高龄组生活质量低于低龄组，差异具有统计学意义(P＜0.05)；没有罹患其他慢性病患者生活质量总得分均值高于罹患其他慢性病患者，差异具有统计学意义(P＜0.05)；稳定收入的患者生活质量总分均值高于不稳定收入和无收入患者，无收入患者生活质量总分均值最低(P＜0.05)；疼痛程度越高，患者生活质量各维度评分越低，生活质量越差，在生活质量各维度不同疼痛程度之间差异有统计学意义(P＜0.01)。
6.Pearson 相关分析表明生活质量各维度与躯体疼痛呈显著相关，差异具有统计学意义（P＜0.05）。
7.多重线性回归表明神经病理性疼痛老年人的生活质量总分受年龄、受教育程度、经济状况、其他慢性病数、疼痛程度影响，差异具有统计学意义（P＜0.05）。
结论：
1.本市神经病理性疼痛老年人生活质量总体偏低,三叉神经痛是石河子市神经病理性疼痛老年人中最主要的疼痛类型。
2.神经病理性疼痛老年人生活质量主要的影响因素有年龄、受教育程度、经济状况、慢性病数、疼痛程度。
3.疼痛是降低本市神经病理性疼痛老年人晚年生活质量的重要因素。
充分考虑这些影响因素，实施相应的干预方案，对提高老年人生活质量来说有重要意义。
关键词：神经病理性疼痛，老年人，生活质量，影响因素.
Abstract
Objective:
1. To investigate the quality of life of the elderly with neuropathic pain in Shihezi, Xinjiang,and analyze the factors affecting the quality of life of the elderly with neuropathic pain, so asto provide guidance for improving the quality of life of the elderly with neuropathic pain.
2. To investigate the prevalence of neuropathic pain in the elderly in Shihezi, Xinjiang, toprovide a basis for the treatment of diseases.
Methods:
1. In this study, convenience sampling was used to select subjects in two hospitals (Shihezipeople's Hospital, First affiliated Hospital of School of Medicine in Shihezi University) fromJanuary 2016 to December 2017 in Shihezi, Xinjiang. The elderly aged over 60 withneuropathic pain, who were treated at the above two hospitals, were the subjects of the study.
A questionnaire survey was conducted among 248 elderly people who met the criteria ofinclusion and exclusion, including general data of patients, BMI body mass index, quality oflife survey, pain assessment and etiological investigation.
2. All the data were established by EpiData3.0 to establish Database and analyzed bySPSS19.0 statistical software. The table was drawn by EXCEL, the enumeration data isdescribed by the number of examples and the constituent ratio;the measurement data isrepresented by “ x ± s”; Single factor analysis was performed with independent sample t-test,variance analysis and Pearson correlation analysis; and multiplicity was performed withmultiple linear regression analysis,the difference was statistically significant when P<0.05.
Results:
1.A total of 262 questionnaires were sent out, 248 valid questionnaires were collected, andthe recovery efficiency was 94.66%.
2.According to the results of VAS pain score, 47 cases (18.95%) with mild pain, 126 cases(50.81%) with moderate pain and 75 cases (30.24%) with severe pain, the average scores ofall elderly patients were 5.85±3.19 points.
3.In 248 elderly patients, 137 cases of primary NP (55.24%), 111 cases of secondary NP(44.76%), central neuralgia (8.06%) and peripheral neuralgia (91.94%). The central neuralgiawas 8.06% and the peripheral neuralgia was 91.94% according to the position of pain. Thetop five diseases were douloureux tic (32.66%), radiculalgia (14.52%), cancer-related pain(14.11%), glossopharyngeal neuralgia (8.06%) and postherpetic neuralgia (7.26%).
4.In this study, the SF-36 quality of life scale was used to do cross-sectional study of the elderly with neuropathic pain in two hospitals of Shihezi City, with a total score of 55.45±16.72 points.
5.Single factor analysis showed that there was no statistically significant in quality of lifedifference between men and women (P ＞ 0.05); There was no statistically significant inquality of life difference between patients living in rural and urban areas (P＞0.05); Therewas no statistically significant in the difference of mean of total quality of life (QOL)between normal, lean, overweight and obese patients (P＞0.05); The quality of life in theelderly group was significantly lower than that in the younger group and the difference wasstatistically significant (P＜0.05); The total score mean of quality of life of patients withoutother chronic diseases was higher than that of patients with other chronic diseases and thedifference was statistically significant (P＜0.05); The total score mean of quality of life ofpatients with stable income was higher than that of patients with unstable income and withoutincome, and the total score mean of quality of life of patients with no income was the lowest(P＜0.05); The higher the degree of pain, the lower the quality of life dimension score andthe worse the quality of life. There was statistical significance among the groups of degree ofpain in all dimensions of QOL (P＜0.01).
6.Pearson correlation analysis showed that all dimensions of QOL were significantlycorrelated with somatic pain and the difference was statistically significant (P＜0.05).
7.Multiple linear regression analysis showed that the total score of quality of life in theelderly with neuropathic pain was affected by age, education level, economic status, numberof chronic diseases, and degree of pain and the difference was statistically significant (P＜0.05).
Conclusion：
1.As a whole, the quality of life of the elderly with neuropathic pain was on the low side inthis city.Douloureuxtic is the main type of pain in the elderly with neuropathic pain inShihezi City.
2.The main influencing factors are age, education level, economic status, number of chronicdiseases, and degree of pain.
3.Pain is an important factor to reduce the quality of life of the elderly patients withneuropathic pain.
It is great significance to improve the quality of life of the elderly by fully considering theseinfluencing factors and carrying out the corresponding treatment plan.
Key words: Neuropathic Pain, Elderly, Quality of Life, Influencing Factors.
目 录
第一章 前言
1.1 研究背景和意义
如今随着社会的不断进步和发展，民众的健康观念已由单纯的对生命的量的追求（寿命）转变为既重视生存时间，同时更加重视生存质量。世界卫生组织(WHO)将生活质量定义为：生活于不同文化和价值体系中的个人对与其目标、期望、标准及关注问题有关联的生存状况的体验。生活质量作为一项新的健康观念，不仅关注患者的寿命有多长，同时更关注患者生活的好不好。
2008 年国际疼痛研究协会神经病理性疼痛特别兴趣小组（NeuPSIG）将神经病理性疼痛（Neuropathic pain，NP）定义为：“由躯体感觉系统的损害或疾病导致的疼痛”
NP 的临床表现复杂多样，具有自己独特的性质和特点。主要表现为病程长，多数超过3 个月；通常疼痛部位与其受损区域一致；多数原有致痛的病因已消除或得到控制但仍存留疼痛，是公认的最难治疗的疼痛综合征之一。
国外流行病学研究显示：NP 患病率为 6.9%～10%，发病率约 8.2/1000 人/年。美国有 375 万 NP 患者，英国慢性疼痛诊所内中有 25%是 NP 患者。许多文献报道 NP与年龄呈正相关，即随着年龄增长 NP 更易发生，60 岁以上老年人在全部 NP 患者中的比例远高于该年龄段在全国人口的比例，说明了老年人群的易感性。神经性疼痛有多种病因，随着全球人口老龄化、糖尿病发病率增加以及化疗后癌症生存率提高，神经性疼痛的发病率可能会上升。
国外有研究显示 NP 会给患者及其家人的生活造成巨大的直接或间接影响，对患者本人，NP 不仅会严重影响患者生活质量，如睡眠、情绪、日常活动等，严重的还会引起焦虑、抑郁、失眠等情感障碍[11,12]
。对于 NP 患者家人来说，其生活质量也会受到间接不同程度的影响，特别是经济方面将会承受巨额医疗花费的压力。美国 2008 年一项调查发现，每年用于带状疱疹后神经痛（PHN）的治疗费用（不包括诊断）高达3000～9000 美元/人不等，带状疱疹持续疼痛产生的大量医疗费用对公共卫生有重要影响。
相关研究显示，神经病理性疼痛的疾病负担似乎与神经性症状的复杂性、不良结果和治疗决定的困难有关，神经病理性疼痛患者的生活质量不仅受到神经病变的影响，还受到疼痛特征和强度的影响，神经性疾病患者存在疼痛会恶化其生活质量，疼痛甚至可能大于感觉障碍和缺陷对生活质量的影响。横断面研究显示，人口学因素研究中与神经病理性疼痛相关的因素包括年龄偏大、女性、体力劳动、无法工作、住在农村或者市政租用的住房以及受教育程度较低。这些因素增大了罹患神经病理性疼痛的风险，然而这些因素是否同时是降低神经病理性疼痛患者生活质量的危险因素，目前相关研究较少。
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1.2 生活质量的国内外研究现状
1.3 研究目的
第二章 材料与方法
2.1 研究对象
2.2 研究方法
2.3 资料收集方法和质量控制
2.4 统计学分析
2.5 技术路线
第三章 结 果
3.1 患者一般资料
3.2 疼痛评估
3.3 病因调查
3.4 神经病理性疼痛老年人生活质量现状
3.5 影响生活质量的单因素分析
3.6 生活质量各维度与躯体疼痛的相关性分析
3.7 影响生活质量的多因素分析
第四章 讨 论
4.1 神经病理性疼痛老年人的发病原因
4.2 神经病理性疼痛老年人生活质量的总体评价
4.3 神经病理性疼痛老年人生活质量的影响因素分析
第五章 结 论
5.1 结论
5.2 不足与展望
参考文献
