应用双水平气道正压通气无创呼吸机通气治疗的慢性阻塞性肺疾病患者心理状态调查及其影响因素分析

Physiological status and the influencing factors in patients with chronic obstructive pulmonary disease ventilated by bi-level positive airway pressure

目的:应用BIPAP(双水平气道正压通气)呼吸机通气治疗对慢性阻塞性肺疾病患者心身健康的影响及其相关因素。方法:于2005-01/04选择上海瑞金医院集团闵行医院呼吸内科病区、内科5病区应用BIPAP呼吸机通气治疗的慢性阻塞性肺疾病患者50例。均符合2002年中华医学会制定的慢性阻塞性肺疾病诊治指南中有关慢性阻塞性肺疾病的诊断标准,意识清醒,能正确回答各项问题,并自愿接受各种量表调查,其中男29例,女21例。采用一般情况调查表调查患者的年龄、性别、职业、生活自理情况等,采用症状自评量表评定患者的精神症状,包括90个条目和10个因子,采用Likter5级评分法,得分越高精神症状越严重。主要观察应用BIPAP呼吸机的患者症状自评量表得分情况,采用多元回归分析影响其心理健康状况的主要因素。计量资料以x±s表示,组间比较采用t检验。结果:纳入50例患者全部进入分析。①症状自评量表得分情况:使用BIPAP呼吸机患者症状自评量表总得分、阳性项目数及其躯体化、人际关系、焦虑、偏执因子得分均显著高于全国常模(t=-11.581～6.328,P<0.001～0.05);女性患者症状自评量表总均分明显高于男性患者(t=-2.028,P<0.05),生活不能自理患者的得分明显高于生活能够自理者(t=-2.104,P<0.05)。②多元逐步回归分析结果:以症状自评量表总分为因变量,以性别、经济状况、疾病知识、病程、使用呼吸机次数、生活自理情况为自变量,进行多元逐步回归分析,结果只有性别、生活自理情况进入回归方程,提示性别及生活自理情况是影响应用BIPAP呼吸机治疗的患者心理状态的主要因素。结论:使用BIPAP无创呼吸机通气治疗的患者存在明显焦虑、自卑、懊丧,以及与人际交流有关的自我敏感、失望、悲观、主观身体不适、猜疑等精神症状,女性及生活不能自理者尤其严重。应加强使用BIPAP呼吸机治疗的慢性阻塞性肺疾病患者的生活护理及心理支持,以减轻呼吸机治疗对其心身的不良影响。

AIM： To explore the psychological effects and relative factors in patients with chronic obstructive pulmonary diseases （COPD） ventilated by Bi-level Positive Airway Pressure （BIPAP）. METHODS： Fifty cases with COPD ventilated by BIPAP in wards of Respiratory Medicine and the fifth Department of Internal Medicine in Minhang Hospital, Ruijing Hospital Group in Shanghai from January to April 2005 were selected. The patients were all in accord with the diagnostic criteria of COPD designed by Chinese Medical Association in 2002, and the patients include 29 males and 21 females who could answer every question correctly and volunteer to investigate all kinds of scales. The general condition was researched by using a general condition investigating, including age, sex, occupation, living things, etc. The psychiatric symptom of patients was assessed with symptom checklist-90 （SCL-90）, containing 90 items and 10 factors, applying Likter 5 grades score. The higher the score, the more severe the psychiatric symptom was. Scores of SCL-90 were observed mainly with BIPAP breathing machine. The main factors affected their psychological health were analyzed with multiple regression analysis. The measurement data expressed with Mean ±SD. The t-test was applied by groups. RESULTS： The 50 included patients were all involved in the result analysis. （1） Scores of SCL-90： Total score of SCL-90 of patients using BIPAP breathing apparatus, number of positive item and scores on somatization, interpersonal sensitivity, anxiety and phobic anxiety were all higher significantly than those of national norms （t =-11.581-6.328,P 〈 0.001-0.05）. Total score of SCL of female patients was higher obviously than that of males （t=-2.028,P 〈 0.05）. Scores of patients who could not care their living were higher markedly than those in patient who could care their living （t=-2.104,P 〈 0.05）. （2） Result of multiple step regression analysis： Total score of SCL-90 was considered as dependent variable. Sex, economic status, knowledge disease, progressive disease, the times that applied by BIPAP and the self-care of living were considered as independent variable to conduct multiple step regression analysis. The result revealed that only sex and self-care of living entered regressive equation, which indicated that sex and self-care of living were the main factors of affecting the mental state of patients applied with BIPAP. CONCLUSION： The patients ventilated by BIPAP have obvious the mental symptoms including anxiety, self-abasement, depression, one＇s sensitivity, disappointment, pessimism, subjective malaise of body and suspicious and so on, especially in females and those who are not able to care their life. Nursing life and physiological support in the patients ventilated by BIPAP should be reinforced so as to relieve physiopsychic bad effects of therapy with breathing machine.