Related Factors In Postoperative Fatigue

BackgroundPostoperative 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.ObjectivesThe 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.MethodsFrom 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.Results1. 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.Conclusions1.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.