重症创伤患者ICU后综合征心理障碍影响因素分析

Analysis of Influencing Factors of Post-ICU Syndrome Psychological Disorders in Severe Trauma Patients

目的:探究重症创伤患者ICU后综合征(PICS)心理障碍影响因素。方法:本次研究纳入60例重症创伤患者,按照是否存在PICS分为对照组(20例)和PICS组(40例)。进行不同治疗情况PICS心理障碍影响因素单因素分析。PICS心理障碍患者急性生理与慢性健康状况评分系统(APACHEⅡ)和医院焦虑和抑郁量表(HADS)评分、Ogawa改良创伤评分系统、匹兹堡睡眠质量指数量表(PSQI)评分进行单因素分析,并进行PICS心理障碍的相关性分析,PICS心理障碍影响因素Logistic回归分析。结果:(1)PICS组年龄<30比例较对照组升高,30-50患者比例较对照组降低(P<0.05)。PICS组文化程度文盲和小学患者比例较对照组升高,初中和高中及以上患者比例较对照组降低(P<0.05)。(2)PICS组手术、手术时间1~3 h和>3 h、ICU时间10~14 d、镇静药物和有创机械通气患者比例较对照组升高(P<0.05)。(3)PICS组APACHEⅡ评分<20和20~25患者比例较对照组降低,APACHEⅡ评分25~30和>30患者比例较对照组升高(P<0.05);PICS组HADS评分<5和5~15患者比例较对照组降低,HADS评分15~25和≥25患者比例较对照组升高(P<0.05);PICS组得分低于9分的轻度损伤者和得分10~16分的中度损伤的患者比例较对照组降低,得分≥17分为重度损伤的患者比例较对照组升高(P<0.05);PICS组得分≤7分的睡眠质量较好的患者比例较对照组降低(P<0.05),得分>7分的睡眠障碍的患者比例较对照组升高(P<0.05)。(4)PICS组年龄、手术时间、ICU时间、APACHEⅡ评分、HADS评分、PSQI得分以及创伤指数评分较对照组升高(P<0.05);(5)PICS心理障碍与年龄、文化程度、手术时间、ICU时间、镇静药物、无创机械通气、有创机械通气、APACHEⅡ评分、HADS评分、创伤指数评分以及PSQI评分相关(P<0.05)。结论:PICS组年龄、手术时间、ICU时间、APACHEⅡ评分和HADS评分较对照组升高;PICS心理障碍与年龄、文化程度、手术时间、ICU时间、镇静药物、无创机械通气、有创机械通气、APACHEⅡ评分、HADS评分、创伤指数评分以及PSQI评分相关。

Objective: To explore the influencing factors of psychological disorders of post-ICU syndrome(PICS) in severe trauma patients. Methods: In this study, 60 patients with severe trauma were enrolled and divided into control group(20 cases) and PICS group(40 cases) according to the presence or absence of PICS. Univariate analysis was conducted on the influencing factors of PICS psychological disorders under different treatment conditions. The APACHEⅡ, HADS, Ogawa and PSQI were used for univariate analysis.The correlation analysis of PICS psychological disorders was conducted. Logistic regression analysis of influencing factors of PICS psychological disorders. Results:(1) The proportion of patients aged <30 of PICS group was higher than that of control group, and 30-50was lower than that of the control group(P<0.05). The proportion of illiterate and primary school patients in PICS group was higher than that in control group, while the proportion of middle school and high school patients was lower than that in control group(P<0.05).(2)Compared with the control group, the proportion of patients with surgery, operation time 1-3 h and > 3 h, ICU time 10-14 d, sedative drugs and invasive mechanical ventilation was higher in PICS group(P<0.05).(3) The proportion of patients with APACHEⅡ score <20and 20-25 in PICS group was lower than that in control group, while the proportion of patients with APACHEⅡ score 25-30 and > 30 was higher than that in control group(P<0.05);the proportion of patients with HADS score less than 5 and 5-15 in PICS group was lower than that in control group, and the proportion of patients with HADS score 15-25 and ≥25 was higher than that in control group(P<0.05);in the PICS group, the proportion of patients with mild injury and moderate injury whose score was lower than 9 and 10-16 was lower than the control group, and the proportion of patients with severe injury whose score was ≥17 was higher than the control group(P<0.05);the proportion of patients with good sleep quality with a SCORE of 7 or less in the PICS group was lower than that in the control group, the proportion of patients with sleep disorders with scores greater than 7 was higher than that of the control group(P<0.05).(4) Age,operation time, ICU time, APACHEⅡ score, HADS score, PSQI score and trauma index score in THE PICS group were higher than those in the control group(P<0.05).(5) ICS disorders were associated with age, education level, duration of surgery, ICU duration, sedatives,non-invasive mechanical ventilation, invasive mechanical ventilation, APACHEⅡ score, HADS score, trauma index score, and PSQI score(P<0.05). Conclusion: The age, operation time, ICU time, APACHEⅡ score and HADS score in PICS group were higher than those in control group. Psychological disorders of PICS were correlated with age, education level, operation time, ICU time, sedatives,non-invasive mechanical ventilation, invasive mechanical ventilation, APACHEⅡ score, HADS score, trauma index score and PSQI score.