ICU患儿发生心理异常反应的临床表现及应对措施

Clinical Presentation of Abnormal Psychological Reaction of ICU Children and Corresponding Intervention

目的探讨ICU患儿发生心理异常反应的临床表现及应对措施。方法 2009年10月至2010年10月ICU收治146例患儿(年龄大于1岁,住院超过3天),当患儿进入恢复期,并停止药物镇静后,医务人员观察其语言行为,发现有25例患儿出现心理异常反应。在出院后追踪6个月,根据父母的反馈了解病情转归。分析总结心理异常反应的临床表现和应对措施。结果 ICU患儿发生心理异常反应的临床表现包括恐惧、噩梦、麻木、异常顺从、反抗行为、攻击行为、刻板动作、语言倒退,甚至心律失常及一些轻微症状。通过医务人员和家长的干预可以减轻患儿的症状。采取的应对措施包括加强心理护理、及时请心理专业人员会诊、尽早转入陪护病房、必要时心理康复治疗。通过心理干预大部分患儿可恢复正常。结论心理异常反应的临床表现多种多样,医务人员应提高意识,及时发现患儿的心理异常反应,并积极采取应对措施,可以促进患儿心理康复。

Objective To investigate clinical presentation of abnormal psychological reaction of PICU children and corresponding intervention. Methods 146 patients were admitted to PICU from October 2009 to October 2010 （above 1 year of age with more than 3-day hospitalization ）. We investigated these children＇ s verbal behavior change in recovery period after quitting depressants and revealed that 25 out of 146 children developed abnormal psychological reaction. We also carried out 6-month followed up with the 10 children after discharge to learn their psychological outcome based on parents＇ feedback. Analyses were made regarding clinical presentation of abnormal psychological reaction as well as effectiveness of psychological intervention. Result Clinical presentation of abnormal psychological reaction of PICU children include： some mild symptoms, fear, nightmare, insensitivity, unusual obe- dience, oppositional defiant, aggressive behavior, language regression and even arrhythmia. These conditions might be relieved through psychological intervention by both medical practitioners and parents. Strategies of corresponding intervention include enhanced psychological care, prompt psychological consultation, early transfer to chaperon ward, and even psychological rehabilitation if necessary. Most of the children had recovered through psychological intervention. Conclusion There are a variety of clinical presentations of abnormal psychological reaction. Medical practitioners should raise the awareness of and identify the development of abnormal psychological reaction and provide timely intervention, by which psychological recovery of these children will be improved.