手术患儿父母医疗创伤应激症状的发展轨迹及影响因素:基于潜变量增长混合模型研究

Development trajectory and influencing factors of pediatric medical traumatic stress in parents with children undergoing surgery:a latent growth mixture model

目的探讨手术患儿父母医疗创伤应激症状的发展轨迹及影响因素,为后期针对性制订干预措施提供参考。方法采用纵向前瞻性研究设计,于2022年1—8月便利抽样法选取中国科学技术大学附属第一医院小儿外科病房收治的199名手术患儿父母作为研究对象。采用创伤后应激障碍检查表第5版在患儿术前1 d、术后恢复期、出院复诊后及出院后3个月追踪调查其父母的医疗创伤应激症状水平,采用一般资料调查表、父母用疾病不确定感量表、医院焦虑抑郁量表、简易应对方式问卷及领悟社会支持量表在患儿术前1 d调查其父母医疗创伤应激症状的影响因素,利用潜变量增长混合模型及二元Logistic回归分析数据。结果手术患儿父母医疗创伤应激症状水平发展轨迹分为2个潜在类别,一是低水平下降型(90.5%,180/199),二是高水平稳定型(9.5%,19/199)。二元Logistic回归分析显示,患儿术后并发症、患儿手术类型和父母消极应对方式均是手术患儿父母医疗创伤应激症状发展轨迹的主要影响因素(均P<0.05)。结论手术患儿父母医疗创伤应激症状存在群体异质性轨迹,医护人员可根据其轨迹及影响因素制订针对性的个体化干预方案。

ObjectiveTo explore the development trajectory and influencing factors of pediatric medical traumatic stress in parents of children undergoing surgery,so as to provide reference for targeted intervention measures in the later stage.MethodsAdopting prospective research design,from January 2022 to August 2022,convenience sampling was used to recruit 199 parents of children undergoing surgery in the pediatric surgery ward of the First Affiliated Hospital of University of Science and Technology of China as subjects.The level of medical traumatic stress symptoms in parents was investigated by the PTSD Checklist for DSM-5 at one day before surgery,during postoperative recovery,after discharge and 3 months after discharge.The general data questionnaire,Parents′Perception of Uncertainty Scale,Hospital Anxiety and Depression Scale,Simplified Coping Style Questionnaire and Perceived Social Support Scale were used to investigate the influencing factors of medical traumatic stress symptoms in parents one day before the operation.Latent growth mixture model and binary Logistic regression were used to analyze the data.ResultsThe development trajectory of pediatric medical traumatic stress in parents of children undergoing surgery was divided into two categories:the first was low-level decline(90.5%,180/199)and the second was high-level stability(9.5%,19/199).Binary Logistic regression analysis showed that postoperative complications,surgical type and negative coping styles of parents were the main influencing factors of pediatric medical traumatic stress trajectory in parents of surgical children(all P<0.05).ConclusionsThe pediatric medical traumatic stress in parents of children undergoing surgery have group heterogeneity trajectory,medical staff can formulate targeted and individualized intervention programs according to their trajectories and influencing factors.