心脏瓣膜置换术后精神障碍发生的相关因素分析及护理对策研究

Study for the nursing strategy and related factors analysis of mental disorders after heart valve replacement

目的通过观察309例心脏瓣膜置换患者的临床资料及术后发生精神障碍情况,分析研究与心脏手术后发生精神障碍可能的相关因素与护理对策。方法统计2008～2010年309例心脏瓣膜手术患者的临床资料,术后通过PTSS-10精神障碍诊断量表对患者进行心脏瓣膜置换术后精神障碍的诊断,回顾分析其中出现精神障碍的30例患者的临床资料和随访资料,分析患者的一般资料及围手术期资料中是否存在与心脏手术后精神障碍有关的因素。采用χ2、Logistic多因素回归模型进行统计分析。结果从全因素的Logistic回归模型上来看,性别、年龄、文化、入院心功能、手术所用时间、体外循环及患者在ICU中时间可能为术后精神障碍的危险因素,其中,又以年龄、在ICU时间、手术时间、性别与术后精神障碍密切相关。结论心脏瓣膜置换术后精神障碍的发生是包括生理机能、环境、心理因素在内的多种因素共同作用的结果,高龄、ICU中滞留时间长、手术时间长、女性,可能更易患术后精神障碍,应对这些患者早期给予关注并采取综合防治措施,积极治疗,有利于患者康复。

Objective To analysis the related factors of mental disorders after heart valve replacement and it＇s nursing strategy based on observation of clinical information and postoperative incidence of mental disorders among 309 patients with heart valve replacement. Method Clinical dates of 309 patients with cardiac valve surgery from the year of 2008 to 2010 was analyzed. Clinical information and follow-up data of 30 cases of mental disorders was retrospectively analyzed. The general information and post operative material disorder after cardiac surgery and related factors was analyzed by statistical methods, such as x^2 and logistic regression model. Result Based on the logistic regression model, the gender, age, culture, hospital heart function, the brain and operation time, patients with cardiopulmonary bypass and time in the ICU may be as a postoperative risk factors of mental disorders, among these, the age, time in ICU, surgical time, sex was closely related to mental disorders. Conclusion The mental disorders was result from several factors interaction, including physiological function, environmental, psychological factors for patients after heart valve replacement. Mental disorders may easily happen among the old patients, long time stay in ICU, the operation time and female. Psychological intervention and treatment should be adapted for these patients.