严重创伤后患者发生应激障碍的危险因素分析

Risk factors of stress disorder in patients with severe trauma

目的探讨严重创伤后患者发生应激障碍的危险因素。方法选择2016年1月—2017年1月宁波市第二医院收治创伤患者327例,收集患者的一般情况、病情、住院期间治疗情况等资料,分析创伤后应激障碍的危险因素。结果根据创伤后应激障碍自评量表(PTSD-SS)评分,本组患者中109例合并创伤后应激障碍,发生率为33.3%。应激障碍组患者序贯器官衰竭评估(SOFA)评分≥5分、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分≥20分、颅内损伤、开放性损伤、多脏器功能损伤、休克、脓毒症、机械通气、持续血液滤过的患者均高于未发生应激障碍患者,差异有统计学意义(χ^2值分别为146.653、137.555、97.909、107.874、58.888、72.951、68.323、93.551、87.138;P<0.05)。Logistic回归分析显示,SOFA评分≥5分、APACHEⅡ评分≥20分、休克、脓毒症是创伤后应激障碍的独立危险因素(OR值分别为8.834、5.578、7.275、22.708;P<0.05)。结论SOFA评分≥5分、APACHEⅡ评分≥20分、休克、脓毒症是严重创伤后应激障碍的独立危险因素,对创伤患者应高度警惕应激障碍的发生风险。

Objective To explore the risk factors of stress disorder in patients after severe trauma. Methods A total of 327 cases of trauma patients in Ningbo Second Hospital from January 2016 to January 2017 were selected. The general conditions and treatment status during hospitalization were collected to analyze the risk factors of post-traumatic stress disorder (PTSD). Results According to the score of Post-Traumatic Stress Disorder Self-Rating scale (PTSD-SS), 109 cases were complicated with PTSD, with an incidence rate of 33.3%. The incidence of Sequential Organ Failure Assessment (SOFA) score ≥5, Acute Physiology and Chronic Health Evaluation Scoring System Ⅱ(APACHEⅡ) score≥20, intracranial injury, open injury, multiple organ dysfunction, shock, sepsis, mechanical ventilation, continuous hemofiltration in PTSD patients was higher than that in non-PTSD patients, and the differences were statistically significant (χ^2=146.653, 137.555, 97.909, 107.874, 58.888, 72.951, 68.323, 93.551, 87.138;P<0.05). Logistic regression analysis showed that SOFA score ≥5, APACHEⅡ score ≥20, shock and sepsis were independent risk factors for PTSD (OR=8.834, 5.578, 7.275, 22.708;P<0.05). Conclusions SOFA score ≥5, APACHEⅡ score ≥20, shock and sepsis were independent risk factors for PTSD. The risk of stress disorder should be highly alerted to traumatic patients.