影响创伤性骨折住院患者急性应激障碍的独立危险因素及干预措施

Independent risk factors and intervention measures of ASD in hospitalized patients with traumatic fracture

目的研究影响创伤性骨折住院患者急性应激障碍(ASD)的独立危险因素及干预措施。方法选取2016年8月至2017年9月广东省深圳市龙岗区第二人民医院收治的创伤性骨折住院患者300例为研究对象,依据斯坦福急性应激反应问卷(SASRQ)及ASD诊断标准将ASD患者纳入研究组(n=75),无ASD患者纳入对照组(n=225),采用一般资料问卷、心理弹性量表(CD-RISC)、医院焦虑抑郁量表(HAD)、社会支持评定量表(SSRS)及创伤严重程度评分法(AIS-ISS)、疼痛视觉模拟评分法(VAS)分析影响创伤性骨折住院患者ASD的单因素及独立危险因素,同时将ASD患者随机分为干预1组、干预2组,分别实施常规干预、综合干预,比较其干预效果。结果研究组性别、年龄、性格、创伤史、并发症、受伤时恐惧比例与对照组比较差异有统计学意义(P <0. 05);研究组CD-RISC、SSRS评分低于对照组,HAD、AIS-ISS、VAS评分高于对照组(P <0. 05);多因素logistic回归分析结果显示,性别、并发症、受伤时恐惧、焦虑抑郁、疼痛感强为创伤性骨折患者发生ASD的独立危险因素(P <0. 05),而社会支持水平、心理弹性水平高是保护因素(P <0. 05);干预后干预1组干预有效率90. 00%,高于干预2组的71. 43%(P <0. 05)。结论创伤性骨折患者会受多因素影响而发生ASD,采取综合性干预措施(药物联合心理干预)可获得有较好效果。

Objective To study the independent risk factors and intervention measures of acute stress disorder （ASD） in hospitalized patients with traumatic fracture. Methods Three hundred cases of hospitalized patients with traumatic fracture treated in Longgang Second People＇s Hospital of Shenzhen from August 2016 to September 2017 were selected for the study and divided into study group （ n =75, with ASD） and control group （ n =225, without ASD） according to the Standford Acute Stress Reaction Questionnaire （SASRQ） and ASD diagnostic criteria. The general information questionnaire, Connor-Davidson resilience scale （CD-RISC）, hospital anxiety and depression scale （HAD）, social support rating scale （SSRS） and injury severity score （AIS-ISS） and visual analogue scale （VAS） were used to analyze the single factors and independent risk factors for ASD in hospitalized patients with traumatic fracture. ASD patients were randomly divided into intervention group 1 and intervention group 2, which were then given the routine intervention and comprehensive intervention respectively, and the intervention effect was compared. Results There was significant difference in gender, age, personality, trauma history, complications and fear of injury between study group and control group （ P 〈0.05）. The scores of CD-RISC and SSRS in study group were lower than those in control group, while the scores of HAD, AIS-ISS and VAS were higher than those in control group （ P 〈0.05）. Multivariate logistic regression analysis showed that gender, complications, fear of injury, anxiety and depression, and intense pain were independent risk factors for ASD in patients with traumatic fracture （ P 〈0.05） while the high levels of social support and psychological resilience were the protective factors （ P 〈0.05）. After intervention, the effective rate of intervention in intervention group 1 was significantly higher than that in intervention group 2 （90% vs 71.43%, P 〈0.05）. Conclusion Traumatic fracture patients will be affected by multiple factors for ASD occurrence, and the comprehensive intervention measures （drug combined with psychological intervention） can achieve a satisfactory effect.