机械通气脱机后患者发生创伤后应激障碍的危险因素分析

Analysis of risk factors for PTSD after mechanical ventilation

目的探讨有创机械通气患者脱机后发生创伤后应激障碍（PTSD）的危险因素。方法将新疆医科大学第一附属医院呼吸重症监护病房（RICU）、外科重症监护病房（SICU）、急诊重症监护病房（EICU）2013年1月～2014年12月210例有创机械通气脱机（除外全麻后脱机患者）作为研究对象，所有患者脱机后1个月均由心理医学科专科医师依据美国精神病疾病诊断准则手册Ⅳ（DSM—Ⅳ）标准，以PTSD症状检查量表（PCL-17）为测量工具诊断为创伤后应激障碍，根据是否患PTSD分为PTSD组和非PTSD组，采用x^2检验、非条件Logistic回归分析在这一人群中发生PTSD的危险因素。结果最终176例患者完成了试验，PTSD组37例（21．02％）和非PTSD组139例（78．98％）。对于PTSD的发生率，年龄〉45岁者高于18-45岁（26．47％比13．51％），女性高于男性（31．15％比15．65％），既往有精神疾病患者高于无精神疾患者（92．59％比8．05％，），机械通气时间〉21d者高于≤21d者（30．14％比14．56％），机械通气期间未给予有效镇静镇痛治疗者高于给予有效镇静镇痛治疗者（31．03％比16．10％），差异均有统计学意义（P〈0．05或P〈0．01）。而在文化程度、民族、宗教信仰等方面差异无统计学意义（P〉0．05）。非条件Logistic回归分析显示，〉45岁（OR=2．304，95％CI：1．037—5．120）、女性（OR=2．438。95％C／：1．164～5．106）、既往有精神疾患（OR=142．708，95％CI：30．095～676．720）、机械通气时间〉21d（OR=2．531，95％CI：1．206～5-312）及机械通气期间未行有效镇静镇痛（OR=0．426，95％CI：0．203—0．896）是机械通气患者脱机后患PTSD的危险因素（P〈0．05或P〈0．01）。结论大于45岁、女性、既往有精神疾患、机械通气时间大于21d、机械通气期间未行有效镇静镇痛等因素是机械通气患者脱机后患PTSD的危险因素。

Objective To investigate the risk factors for PTSD in patients after weaning. Methods 210 patients in RICU, SICU and EICU of the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2014 （excluding weaning post-general anesthesia）, and they were diagnosed as PTSD by psychologist one month after weaning with PCL-17 according to DSM-IV, they were divided into PTSD group and non-PTSD group, then the risk factors were analyzed with X^2 test and Logistic correlation analysis. Results 176 patients completed experiment test, 37 cases （21.02%） in the PTSD group, 139 cases （78.98%） in the non-PTSD group. The incidence of PTSD： patients whose age 〉 45 years were higher than the 18-45 years （26.47% vs 13.51%）, female was higher than male （31.15% vs 15.65%）, patients with history of mental disease was higher than those without mental disease （92.59% vs 8.05%）, mechanical ventilation time 〉 21 day was higher than mechanical ventilation time ≤21 day （30.14% vs 14.56% ）, mechanical ventilation duration without effective sedation and analgesia treatment was higher than patients with effective sedative and analgesic therapy （31.03% vs 16.10%）, the differences were statistically significant （P 〈 0.05 or P 〈 0.01）.There were no significant differences in degree of culture, nation, religion and other aspects （P 〉 0.05）. Logistic regression analysis showed that, 〉 45 years （OR =2.304, 95%CI： 1.037-5.120）, female （OR=2.438, 95%CI： 1.164-5.106）, psychiatric history （OR=142.708, 95%CI： 30.095＇676.720）, the duration of ventilation 〉 21 days （OR=2.531, 95%CI： 1.206-5.312） and without effective sedation and abirritation during mechanical ventilation （OR=0.426, 95%CI： 0.203-0,896） were the risk factors for PTSD. Conclusion The age more than 45years old, female, psychiatric history, the duration of ventilation more than 21 days, without effective sedation and abirritation during mechanical ventilation are the risk factors for PTSD.