ICU患者创伤后应激障碍发生及其影响因素研究
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摘要
目的探究与分析重症监护病房(ICU)患者创伤后应激障碍(PTSD)发生及其影响因素。方法选择2016年6月～2018年6月哈尔滨医科大学附属第一医院收治的经历过综合性ICU后病情稳定且意识清醒的86例患者作为研究对象,利用基本情况调查表、事件影响量表修订版(IES-R)、ICU机械通气患者重症监护体验量表(ICE-MV)对患者进行评价,探讨ICU患者PTSD发生及其影响因素。结果患者的PTSD得分为1～57分,平均(33.45±12.73)分,在三个维度中,侵袭维度因子分(该维度条目总分/该维度条目数)最高。将PTSD总分作为因变量,将机械通气与否、不同手术类型、ICU停留时间、情绪状态、既往严重创伤史、酒精依赖史、负性生活事件纳入自变量,经Logistic多因素回归分析,可见机械通气与否、ICU停留时间、情绪状态、既往严重创伤史、负性生活事件是影响PTSD发生的影响因素(P <0.05)。结论机械通气与否、ICU停留时间、情绪状态、既往严重创伤史、负性生活事件可作为影响PTSD发生的高危影响因素,临床工作人员需要对此制订不同的干预措施,从而保障患者的生命健康。
Objective To explore and analyze the occurrence of post-traumatic stress disorder(PTSD) in patients in intensive care unit(ICU) and its influencing factors. Methods From June 2016 to June 2018, 86 patients admitted to the First Affiliated Hospital of Harbin Medical University who had undergone comprehensive ICU and with stable condition and consciousness were selected as study subjects. The patients were evaluated by the basic situation questionnaire and the Impact of Event Scale-Revised(IES-R) and Intensive Care Experience with Mechanical Ventilation(ICE-MV) to explore the occurrence and influencing factors of PTSD in ICU patients. Results The patient′s PTSD score was 1 to 57 points, with an average of(33.45±12.73) points. In the three dimensions, the invasive dimension factor score(total score of the dimension items/the number of the dimension items) was the highest. Using the total score of PTSD as a dependent variable, mechanical ventilation or not, different types of surgery, ICU stay time, emotional state, previous severe trauma history, history of alcohol dependence, and negative life events were included in the independent variables. Logistic multivariate regression analysis showed that mechanical ventilation or not, ICU stay time, emotional state, previous severe trauma history, and negative life events were the influencing factors of PTSD(P < 0.05). Conclusion Mechanical ventilation or not, ICU stay time, emotional state, previous severe trauma history, negative life events can be used as high-risk factors affecting the occurrence of PTSD. Clinical staff need to develop different interventions to protect patients′ life and health.
Objective To explore and analyze the occurrence of post-traumatic stress disorder(PTSD) in patients in intensive care unit(ICU) and its influencing factors. Methods From June 2016 to June 2018, 86 patients admitted to the First Affiliated Hospital of Harbin Medical University who had undergone comprehensive ICU and with stable condition and consciousness were selected as study subjects. The patients were evaluated by the basic situation questionnaire and the Impact of Event Scale-Revised(IES-R) and Intensive Care Experience with Mechanical Ventilation(ICE-MV) to explore the occurrence and influencing factors of PTSD in ICU patients. Results The patient′s PTSD score was 1 to 57 points, with an average of(33.45±12.73) points. In the three dimensions, the invasive dimension factor score(total score of the dimension items/the number of the dimension items) was the highest. Using the total score of PTSD as a dependent variable, mechanical ventilation or not, different types of surgery, ICU stay time, emotional state, previous severe trauma history, history of alcohol dependence, and negative life events were included in the independent variables. Logistic multivariate regression analysis showed that mechanical ventilation or not, ICU stay time, emotional state, previous severe trauma history, and negative life events were the influencing factors of PTSD(P < 0.05). Conclusion Mechanical ventilation or not, ICU stay time, emotional state, previous severe trauma history, negative life events can be used as high-risk factors affecting the occurrence of PTSD. Clinical staff need to develop different interventions to protect patients′ life and health.
引文
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[18]马扬霞.心理弹性水平及睡眠状况对ICU患者创伤性应激障碍水平的预测效果[J].当代护士:上旬刊,2018(4):56-57.
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[20]梁英,焦丹丹,肖文芳,等.烧伤患者创伤后应激障碍及其影响因素研究[J].临床心身疾病杂志,2016,22(4):113-115.
[2] Parker AM,Sricharoenchai T,Raparla S,et al. Posttraumatic stress disorder in critical illness survivors:a metaanalysis[J].Crit Care Med,2015,43(5):1121-1129.
[3]李秀花.探讨优质护理对ICU急性胸腹部创伤患者术后睡眠质量的影响[J].世界最新医学信息文摘,2016,16(27):20-21.
[4]赵红军.ICU脑外伤昏迷患者发生肺部感染的影响因素分析及护理方法研究[J].当代医学,2017,23(4):133-134.
[5]余骄阳.重症感染患者ICU治疗时间影响因素分析[J].浙江创伤外科,2017,22(1):23-24.
[6]刘芳,潘凌蕴.睡眠剥夺对重症监护患者的影响及相关因素研究进展[J].现代临床护理,2015(4):65-68.
[7]黄丽,罗利,胡蓉芳.ICU相关记忆及其影响因素的研究[J].护理学杂志,2015,30(24):70-73.
[8] Talbot LS,Maguen S,Metzler TJ,et al. Cognitive behavioral therapy for insomnia in posttraumatic stress disorder:a randomized controlled trial[J]. Sleep,2014,37(2):327-341.
[9] Nair R,Mitchell M,Keogh S. The extent and application of patient diaries in Australian intensive care units:a national survey[J]. Aust Crit Care,2014,28(2):93-102.
[10]王正国,王庆松,谭庆荣.创伤后应激障碍[M].北京:人民卫生出版社,2015:123-124.
[11]李成莲.ICU患者心理变化影响因素与护理干预措施[J].医学信息,2016,29(17):141-142.
[12]高敏,孙宇,王宇迪,等.ICU创伤后感染患者并发脓毒症的危险因素分析[J].第三军医大学学报,2017,39(4):367-368.
[13]王烁,侯婉玲,胡蓉芳,等.ICU患者创伤后应激障碍危险因素的Meta分析[J].中华护理杂志,2016,51(8):915-922.
[14] Davidson JE,Aslakson RA,Long AC,et al. Guidelines for Family-Centered Care in the Neonatal,Pediatric,and Adult ICU[J]. Crit Care Med,2017,45(1):103-128.
[15]刘凌云,李璐,陈潇,等.ICU出院患者创伤后应激障碍研究进展[J].中国护理管理,2017,1(9):1172-1173.
[16] Rabiee A,Nikayin S,Hashem MD,et al. Depressive Symptoms After Critical Illness:A Systematic Review and MetaAnalysis[J]. Crit Care Med,2016,44(9):1744-1745.
[17]张伟艳,李君颖,余红燕,等.多发伤患者创伤后应激障碍的高危因素及早期护理干预[J].现代实用医学,2017,29(7):974-975.
[18]马扬霞.心理弹性水平及睡眠状况对ICU患者创伤性应激障碍水平的预测效果[J].当代护士:上旬刊,2018(4):56-57.
[19]王灿,陆茵,王玉宇,等.特重度烧伤患者急诊ICU救治早期真实体验的质性研究[J].护理实践与研究,2016,13(24):89-90.
[20]梁英,焦丹丹,肖文芳,等.烧伤患者创伤后应激障碍及其影响因素研究[J].临床心身疾病杂志,2016,22(4):113-115.