摘要
目的了解中青年急性心肌梗死(acute myocardial infarction,AMI)患者术后的创伤后应激障碍(post-traumatic stress disorder,PTSD)情况及PTSD症状群变化轨迹,分析其影响因素,以指导临床干预患者形成良好康复行为。方法采用一般资料调查表、创伤后应激障碍症状问卷中文平民版(PCL-C)、综合性医院焦虑抑郁量表(HADS),对280例中青年急性心肌梗死患者术后3天及出院后3个月、6个月、12个月的心理状态进行随访,基于收集的数据分别构建线性增长曲线模型及不定义增长曲线模型,分析患者创伤后应激障碍症状群的变化轨迹及影响因素。结果111例患者被诊断为PTSD,PTSD阳性率为39.64%,其中106例患者完成全程随访,中青年AMI患者术后PTSD的再体验、回避、情感麻木、高警觉症状群均呈非线性下降趋势(P<0.05)。协变量分析结果显示:女性、存在并发症、术中知晓程度低的患者,PTSD初始水平高(P<0.05);术中知晓程度高的患者,PTSD症状改善快(P<0.05)。不同时期的抑郁、焦虑水平对相应时期的PTSD水平均有正向预测作用(P<0.01)。结论中青年AMI患者术后早期PTSD的发生率较高,症状群变化轨迹呈曲线下降趋势,且受到性别、是否存在并发症、术中知晓程度、抑郁和焦虑的共同影响。
Objective To understand the situation of post-traumatic stress disorder(PTSD)and the changing track of PTSD symptom group in young and middle-aged patients with acute myocardial infarction(AMI)and analyze its influencing factors to guide clinical intervention patients to form good rehabilitation behavior.Methods The psychological status of 280 young and middle-aged patients with acute myocardial infarction three days after the operation and 3,6,and 12 months after discharge were followed up by a general information questionnaire,post-traumatic stress disorder symptom questionnaire Chinese civilian version(PCL-C),and general hospital anxiety and depression scale(HADS).Based on the collected data,a linear growth curve model and an undefined growth curve model were constructed to analyze the change trajectory and influencing factors of patients with post-traumatic stress disorder symptoms.Results A total of111 patients were diagnosed with PTSD,and the positive rate of PTSD was 39.64%.Among them,106 patients completed the whole follow-up.The re-experience,avoidance,emotional numbness,and high vigilance symptoms of PTSD in young and middle-aged AMI patients showed a nonlinear downward trend(P<0.05).The results of covariate analysis showed that the initial level of PTSD was high in women,patients with complications,and low awareness during operation(P<0.05).Patients with high intraoperative awareness improved PTSD symptoms faster(P<0.05).The levels of depression and anxiety in different periods had a positive predictive effect on the level of PTSD in the corresponding period(P<0.01).Conclusions The incidence of early PTSD in young and middle-aged patients with AMI is high,and the change trajectory of symptom groups shows a downward trend,which is affected by gender,whether there are complications,intraoperative awareness,depression,and anxiety.
作者
王雯沁
吴敏娟
李俊花
冯国和
张邢炜
WANG Wenqin;WU Minjuan;LI Junhua;FENG Guohe;ZHANG Xingwei(School of Nursing,Hangzhou Normal University,Hangzhou 311121,China;The Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)
出处
《健康研究》
CAS
2022年第4期415-421,共7页
Health Research
基金
杭州市卫生科技计划(0020190594)
浙江省医药卫生科技计划(2019RC246)。
关键词
心肌梗死
创伤后应激障碍
变化轨迹
症状群
潜变量增长曲线模型
myocardial infarction
post-traumatic stress disorder
trajectory changes
symptom clusters
latent growth curve model
