摘要
目的:探讨重症监护室(ICU)多发伤青少年病人创伤后应激障碍(PTSD)发生现状及潜在类别,并分析不同类别病人创伤后应激障碍的特征差异。方法:选取2022年1月—2023年9月郑州市某三级甲等医院综合ICU收治的304例多发伤青少年病人为研究对象,采用创伤后应激障碍清单-平民版(PCL-C)在转出ICU 1个月时对病人进行评估。对ICU多发伤青少年病人的PTSD症状特征进行潜在剖面分析,并通过无序多分类Logistic回归分析识别其潜在类别的影响因素。结果:ICU多发伤青少年病人PTSD发生率为51.6%,PCL-C得分为(48.26±4.73)分,PTSD症状特征分为3个潜在类别,即应激低发组(31.2%)、症状高发组(38.9%)和警觉性应激组(29.9%)。症状高发组与应激低发组相比,未采用机械通气(OR=0.040,P=0.032)和未使用镇静药物(OR=0.049,P=0.043)的病人归于应激低发组概率更高,创伤严重程度(ISS)评分(OR=1.220,P=0.040)和急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分(OR=1.997,P=0.001)越高,归于症状高发组的概率越高。警觉性应激组和应激低发组相比,男性病人(OR=0.020,P<0.001)归于应激低发组概率更高,APACHEⅡ评分(OR=1.622,P=0.007)越高,归于警觉性应激组的概率越高。结论:ICU多发伤青少年病人PTSD症状存在异质性。性别、机械通气、使用镇静药物、ISS评分、APACHEⅡ评分是ICU多发伤青少年PTSD潜在类别的影响因素。临床医护人员应关注ICU多发伤青少年病人PTSD症状特征的异质性,对不同类别的病人给予针对性干预措施。
Objective:To explore the current status of post-traumatic stress disorder(PTSD)in adolescent patients with multiple injuries in the ICU and to analyse the differences in the potential characteristics of PTSD in different categories of adolescent patients.Methods:304 adolescent patients with multiple injuries in the comprehensive ICU of a tertiary hospital in Zhengzhou from January 2022 to September 2023 were selected.Patients were assessed using the Posttraumatic Stress Disorder Inventory-Civilian version(PCL-C)at 1 month of transfer out of the ICU.The potential profile of PTSD symptoms in adolescent patients with multiple injuries in ICU was analyzed,and the influencing factors were identified by disordered multiple classification Logistic regression.Results:The incidence of PTSD in adolescent patients with multiple injuries in the ICU was 51.6%,with a PCL-C score of 48.26±4.73.PTSD symptom profiles were divided into 3 potential profile categories,which were“a low stress group”(31.2%),“a high symptom group”(38.9%),and“an alert stress group”(29.9%).The probability of being attributed to the stress low group was higher in the symptomatic high group compared to the stress low group in patients who were not mechanically ventilated(OR=0.040,P=0.032)and who were not sedated(OR=0.049,P=0.043)and the probability of being attributed to the stress low group was higher in patients who had a higher ISS score(OR=1.220,P=0.040)and a higher APACHEⅡscore(OR=1.997,P=0.001)were higher,the higher the probability of belonging to the symptomatic high incidence group.Male patients(OR=0.020,P<0.001)had a higher probability of belonging to the stress low group compared to the alert stress group,and higher APACHEⅡscores(OR=1.622,P=0.007)were associated with a higher probability of belonging to the alert stress group.Conclusion:There is heterogeneity in PTSD symptoms in adolescent patients with multiple injuries.Sex,mechanical ventilation,use of sedative drugs or not,ISS scores and APACHEⅡscores were influencing factors of different categories.Clinical staff should pay attention to the heterogeneity of PTSD symptom profiles in adolescent patients with multiple injuries in the ICU and give targeted interventions to different categories of patients.
作者
李丽青
陈震
董子倍
李航博
吴艳梅
闫倩倩
张亚琴
LI Liqing;CHEN Zhen;DONG Zibei;LI Hangbo;WU Yanmei;YAN Qianqian;ZHANG Yaqin(Zhengzhou Central Hospital Affiliated to Zhengzhou University,Henan 450001 China)
出处
《护理研究》
北大核心
2025年第1期40-45,共6页
Chinese Nursing Research
基金
河南省高等学校重点科研项目,编号:22B320020
郑州市2023年度社会科学调研项目,编号:ZSLX20231874。
关键词
重症监护室
青少年
创伤后应激障碍
潜在剖面分析
影响因素
调查研究
intensive care unit,ICU
adolescents
post-traumatic stress disorder,PTSD
potential profile analysis
influencing factors
investigation and research
