医务社工结合ICU日记对ICU车祸伤患者防治创伤后应激障碍的影响

The effect of medical social workers combined with ICU diary on the prevention and treatment of post-traumatic stress disorder in ICU traffic accident patients

目的研究医务社工结合ICU日记对ICU车祸伤患者防治创伤后应激障碍的效果,对ICU车祸伤患者开展延续性护理服务和ICU日记的应用进行探索。方法采用便利抽样法,选取2019年1—12月苏州科技城医院因车祸伤入院的患者47例为研究对象,引入医务社工和ICU日记前6个月的23例患者为对照组,引入医务社工和ICU日记后6个月的24例患者为试验组。对照组给予常规ICU治疗和护理措施,试验组采用医务社工结合ICU日记的模式进行干预。比较2组患者入住ICU时、入住ICU1周、转出ICU后焦虑自评量表得分和抑郁自评量表得分。通过2组患者在出ICU后1、3、6个月的事件影响量表修订版得分来评估创伤后应激障碍发生情况并进行比较。结果试验组患者在入住ICU时、入住ICU1周、转出ICU后焦虑自评量表得分分别为(58.67±7.45)、(44.13±5.47)、(39.08±5.52)分,对照组分别为(58.17±6.75)、(50.87±6.35)、(42.74±4.85)分。2组患者在入住ICU时焦虑自评量表得分差异无统计学意义(P>0.05),但随着时间变化和干预措施不同2组患者存在时间差异(F时间=110.98,P<0.01),也存在组间差异(F组间=5.91,P<0.05),试验组与对照组相比,焦虑量表得分下降趋势更明显(F交互=0.28,P<0.05)。试验组患者在入住ICU时、入住ICU1周、转出ICU后抑郁自评量表得分分别为(57.75±4.06)、(45.29±3.39)、(36.63±3.49)分,对照组分别为(57.48±2.29)、(49.04±5.65)、(43.57±4.07)分。2组患者在入住ICU时焦虑自评量表得分差异无统计学意义(P>0.05),但随着时间变化和干预措施不同2组患者存在时间差异(F_(时间)=248.24,P<0.01),也存在组间差异(F_(组间)=24.39,P<0.05),试验组与对照组相比,抑郁量表得分下降趋势更明显(F_(交互)=10.44,P<0.05)。试验组在转出ICU1、3、6个月发生创伤后应激障碍分别为9、8、6例,低于对照组的12、11、8例,由广义估计方程可知差异有统计学意义(χ^(2)=4.21,P<0.05)。结论医务社工结合ICU日记的干预模式有利于ICU日记的使用和延续性护理的开展,改善了患者的负性情绪和降低创伤后应激障碍的发生率。

Objective To study the effect of medical social workers combined with ICU diary on the prevention and treatment of post-traumatic stress disorder in ICU traffic accident patients,and to explore the application of continuing nursing services and ICU diary to ICU traffic accident patients.Methods A total of 47 patients who were admitted to the ICU of Suzhou Science and Technology City Hospital from January to December 2019 due to traffic accidents were selected by convenient sampling method.Twenty-three patients admitted to the hospital in the first 6 months were selected as the control group(before the introduction of medical social workers and ICU diaries)for routine ICU treatment and nursing mode.Twenty-four patients admitted to the hospital in the last 6 months were selected as the experimental group(after the introduction of medical social workers and ICU diaries),and the medical social workers combined with the ICU diary were intervened.The scores of the Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS)were compared between the two groups of patients when they were admitted to the ICU,stayed in the ICU for a week,and transferred out of the ICU.The incidence of post-traumatic stress disorder was evaluated and compared by the scores of the Impact of Event Scale-Revised of the two groups of patients one month after leaving the ICU,three months after leaving the ICU,and six months after leaving the ICU.Results The scores of SAS in the experimental group were 58.67±7.45,44.13±5.47 and 39.08±5.52 when they were admitted to the ICU,stayed in the ICU for a week,and transferred out of the ICU,and were 58.17±6.75,50.87±6.35 and 42.74±4.85,respectively in the control group.There was no statistical difference in the scores of the SAS between the two groups of patients when they were admitted to the ICU(P>0.05),but there was a time difference between the two groups with time changes and different interventions(Ftime=110.98,P<0.01),there were also differences between groups(Fbetween groups=5.91,P<0.05).Compared with the control group,the SAS score of the experimental group decreased more significantly(Finteraction=0.28,P<0.05).The scores of SDS in the experimental group were 57.75±4.06,45.29±3.39 and 36.63±3.49 when they were admitted to the ICU,stayed in the ICU for a week,and transferred out of the ICU,and were 57.48±2.29,49.04±5.65 and 43.57±4.07 respectively in the control group.There was no statistical difference in the scores of the SDS between the two groups of patients when they were admitted to the ICU(P>0.05),but there was a time difference between the two groups of patients with time changes and different interventions(F_(time)=248.24,P<0.01),there are also differences between groups(F_(between groups)=24.39,P<0.05).Compared with the control group,the SDS score of the experimental group decreased more significantly(F_(interaction)=10.44,P<0.05).The incidences of post-traumatic stress disorder in the experimental group were 9,8,6 cases at one month,three months and six months after leaving the ICU,which were lower than 12,11,8 cases in the control group.The generalized estimation equation showed that the difference was statistically significant(χ^(2)=4.21,P<0.05).Conclusions The intervention model of medical social workers combined with ICU diary is conducive to the use of ICU diary and the development of continuous nursing,which improves patients′negative emotions and reduces the incidence of post-traumatic stress disorder.