急诊创伤手术患者术后创伤后应激障碍的危险因素

Risk factors for post-traumatic stress disorder after emergency trauma surgery

目的:筛选急诊创伤手术患者术后创伤后应激障碍(PTSD)的危险因素。方法:回顾性收集急诊手术创伤患者(车祸、坠落、工程事故等)的病历资料,记录患者一般情况和围术期各项临床指标,根据术后1个月是否发生PTSD分为PTSD组和非PTSD组。采用多因素logistic回归分析法筛选PTSD的危险因素。结果:共纳入312例患者,术后1个月PTSD发生率为19.9%。与非PTSD组比较,PTSD组术前VAS评分、性别比例、术中使用丙泊酚、术中使用右美托咪定和术后入ICU率差异有统计学意义(P<0.05)。logistic回归分析结果显示:术中使用丙泊酚、术前高VAS评分和术后转入ICU是PTSD发生的独立危险因素,术中使用右美托咪定是预防PTSD发生的保护因素(P<0.05)。结论:术中使用丙泊酚、术前高VAS评分和术后入ICU是急诊创伤患者术后PTSD发生的独立危险因素,术中使用右美托咪定是预防PTSD发生的保护因素。

Objective To screen the risk factors for post-traumatic stress disorder(PTSD)after emergency trauma surgery in the patients.Methods The medical records of emergency surgical trauma patients(traffic accident,fall,engineering accident,etc.)were retrospectively collected.The general condition and perioperative clinical indicators of the patients were recorded.The patients were divided into PTSD group and non-PTSD group according to whether PTSD occurred within 1 month after surgery.Multivariate logistic regression analysis was used to screen the risk factors for PTSD.Results A total of 312 patients were enrolled,and the incidence of PTSD at 1 month after surgery was 19.9%.There were significant differences in preoperative VAS score,ratio of gender,intraoperative use of propofol,intraoperative use of dexmedetomidine,and postoperative ICU transfer rate between PTSD group and non-PTSD group(P<0.05).The results of logistic regression analysis showed that intraoperative use of propofol,preoperative high VAS score and postoperative admission to ICU were independent risk factors for PTSD,and intraoperative use of dexmedetomidine was a protective factor for the prevention of PTSD(P<0.05).Conclusions Intraoperative use of propofol,preoperative high VAS score and postoperative transfer to ICU are independent risk factors for postoperative PTSD in the patients with emergency trauma,and intraoperative use of dexmedetomidine is a protective factor for the prevention of PTSD.