高分辨率测压过程中患者报告的及生理性的疼痛与焦虑标志物：一项探索性研究

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中文摘要

目的： 探讨患者报告的及生理性的疼痛与焦虑测量指标如何与静息状态及吞咽过程中的高分辨率测压（HRM）结果相关联。
方法： 从36名门诊成人中收集HRM数据以及患者报告的及生理性的疼痛与焦虑测量指标。采用多变量线性回归模型评估疼痛/焦虑与上食管括约肌（UES）/下食管括约肌（LES）压力及食管动力结局之间的关联。预测变量包括：（1）经验证的自我报告疼痛视觉模拟量表（VAS）；（2）状态-特质焦虑量表总分（STAI）；（3）简式McGill疼痛问卷（SFMPQ）；（4）操作前心率（HR）；以及（5）皮肤电反应平均斜率（GSRslope）。分别在静息状态下评估基础指标的关系，以及在吞咽过程中评估蠕动指标的关系。
结果： 在患者报告的或生理性的焦虑/疼痛测量指标与食管或括约肌测量指标之间，观察到少数具有统计学显著性的关系。然而，吞咽过程中UES平均残余压力与VAS疼痛评分（p = 0.04）及GSRslope（p = 0.01）呈负相关。此外，随着SF-MPQ升高，完整吞咽的百分比下降（校正R2 = 0.146；p=0.012）。
结论： HRM操作过程中的UES静息压力与患者报告的焦虑或疼痛无显著关联。然而，我们观察到UES平均残余压力与患者报告的疼痛及生理性唤醒（GSRslope）之间存在小幅但具有统计学显著性的负相关。未来研究可能受益于在整个HRM操作过程中进行连续生理监测，以及纳入具有更多样化病理的更大样本。

英文摘要

OBJECTIVE: To investigate how patient-reported and physiologic measures of pain and anxiety are associated with high-resolution manometry (HRM) findings at rest and during swallowing.
METHODS: HRM data and patient-reported and physiologic measures of pain and anxiety were collected from 36 outpatient adults. Multivariable linear regression models were used to assess the associations between pain/anxiety and upper esophageal sphincter (UES)/lower esophageal sphincter (LES) pressures and esophageal motility outcomes. Predictor variables included: (1) a validated visual analogue scale (VAS) of self-reported pain; (2) the State Trait Anxiety Inventory sum score (STAI); (3) the Short-Form McGill Pain Questionnaire (SFMPQ); (4) heart rate before the procedure (HR); and (5) average slope of Galvanic Skin Response (GSRslope). Relationships were assessed both at rest for basal measures and during swallowing for peristaltic measures.
RESULTS: Few statistically significant relationships were observed between patient-reported or physiologic measures of anxiety/pain with esophageal or sphincter measures. However, UES mean residual pressure during swallowing was negatively associated with VAS pain ratings (p = 0.04) and the GSRslope (p = 0.01). Additionally, as SF-MPQ increased, the percentage of intact swallows decreased (adjusted R2 = 0.146; p=0.012).
CONCLUSION: UES resting pressure during HRM procedures was not significantly associated with patient-reported anxiety or pain. However, we saw a small statistically significant inverse association between UES mean residual pressure and patient-reported pain and physiologic arousal (GSRslope). Future research may benefit from continuous physiologic monitoring throughout HRM procedures and from inclusion of a larger sample with more diverse pathology.