缺血性脑卒中患者创伤后应激障碍水平及其危险因素分析

Analysis of post-traumatic stress disorder and its risk factors in ischemic stroke patients

目的缺血性脑卒中患者创伤后应激障碍(PTSD)水平及其危险因素分析.方法选择2020年5月至2022年6月舟山市普陀区人民医院收治的183例缺血性脑卒中患者作为观察对象.通过自制调查问卷采集患者基本信息,包括性别、年龄、人格特征、家庭人均月收入、文化水平、婚姻状况、日常生活能力、病程、家庭功能、医保类型、有无吞咽功能障碍、有无基础疾病(心脏病、高血压、高脂血症及糖尿病等)、是否焦虑、应对方式、社会支持水平等,采用PTSD自评量表(PTSD-SS)判定缺血性脑卒中患者并发PTSD的情况,统计PTSD发生率.比较有无PTSD两组患者基本资料的差异,将单因素分析差异有统计学意义的因素纳入多因素Logistic回归分析,筛选出影响缺血性脑卒中患者发生PTSD的危险因素,并绘制受试者工作特征曲线(ROC曲线)评估各危险因素对缺血性脑卒中患者发生PTSD的预测价值.结果183例缺血性脑卒中患者的PTSD-SS评分(48.76±9.21)分,整体处在相对较低水平,其中有37例患者发生PTSD,发生率为20.22%.与无PTSD组比较,有PTSD组患者人格特征内向、日常生活能力重度障碍、有吞咽功能障碍、合并焦虑、消极应对、社会支持度低/无等患者比例明显升高(均P<0.05);多因素Logistic回归分析显示,人格特征内向、日常生活能力重度障碍、有吞咽功能障碍、合并焦虑、消极应对、低水平/无社会支持是缺血性脑卒中患者发生PTSD的独立危险因素[优势比(OR)和95%可信区间(95%CI)分别为2.289(1.091~4.804)、5.842(1.658~20.587)、2.634(1.095~6.333)、7.138(3.255~15.655)、2.751(1.271~5.953)、3.153(1.477~6.733),均P<0.05];ROC曲线分析显示,人格特征内向、日常生活能力重度障碍、有吞咽功能障碍、合并焦虑、消极应对、低水平/无社会支持对缺血性脑卒中患者发生PTSD均有一定的预测价值,ROC曲线下面积(AUC)分别为0.602、0.675、0.573、0.722、0.603、0.624,95%CI分别为1.091~4.804、1.342~9.566、1.095~6.333、3.255~15.655、1.271~5.953、1.477~6.733,均P<0.05;其预测缺血性脑卒中患者发生PTSD的敏感度为58.2%、87.7%、87.7%、79.5%、80.1%、78.8%,特异度为37.8%、67.6%、70.3%、35.1%、59.5%、54.1%.结论缺血性脑卒中患者创伤后具有一定的并发应激障碍风险,且易受脑卒中患者人格特征、日常生活能力、吞咽功能障碍、应对方式及社会支持度等因素的影响,应制定针对性预防干预措施,降低患者并发PTSD的风险,改善预后生存质量.

Objective To analyze the level of post-traumatic stress disorder(PTSD)and its risk factors in patients with ischemic stroke.Methods A total of 183 cases of patients with ischemic stroke treated in Putuo District People's Hospital of Zhoushan City from May 2020 to June 2022 were selected as the observation objects.Basic information of patients was collected by self-made questionnaire,including gender,age,personality characteristics,family per capita monthly income,education level,marital status,ability of daily living,duration of ischemic stroke,family function,type of medical insurance,whether there was swallowing dysfunction,whether there was underlying disease(heart disease,hypertension,hyperlipidemia and diabetes),whether there is anxiety,coping style,level of social support.PTSD self-rating scale(PTSD-SS)was used to determine the complications of PTSD in ischemic stroke patients,and the incidence of PTSD was calculated.To compare the difference in basic information between the two groups of patients with PTSD.Factors with statistically significant differences in univariate analysis were included in multivariate Logistic regression analysis to screen out the risk factors affecting the development of PTSD in patients with ischemic stroke,and receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each risk factor for the development of PTSD in patients with ischemic stroke.Results PTSD-SS score of 183 patients with ischemic stroke(48.76±9.21)was relatively low.Among them,37 case(20.22%)of patients developed PTSD.Compared with the non-PTSD group,the proportion of patients with introverted personality,dysfunctions of daily living,swallowing dysfunction,combined anxiety,negative coping style,and low/no social support was significantly increased in the PTSD group(all P<0.05).Multivariate Logistic regression analysis showed that introverted personality,severe impairment of daily living ability,swallowing dysfunction,combined anxiety,negative coping style,and low/no social support were independent risk factors for PTSD in ischemic stroke patients[odds ratio(OR)and 95%confidence interval(95%CI)were 2.289(1.091-4.804),5.842(1.658-20.587),2.634(1.095-6.333),7.138(3.255-15.655),2.751(1.271-5.953),3.153(1.477-6.733),all P<0.05].ROC curve analysis showed that introverted personality,severe impairment of daily living ability,swallowing dysfunction,combined anxiety,negative coping style,and low/no social support all had certain predictive value for the occurrence of PTSD in ischemic stroke patients,the area under the ROC curve(AUC)was 0.602,0.675,0.573,0.722,0.603,0.624,and 95%CI was 1.091-4.804,1.342-9.566,1.095-6.333,3.255-15.655,1.271-5.953,1.477-6.733,respectively,all P<0.05.The sensitivity to predict PTSD in ischemic stroke patients was 58.2%,87.7%,87.7%,79.5%,80.1%,78.8%,and the specificity was 37.8%,67.6%,70.3%,35.1%,59.5%,54.1%,respectively.Conclusions Ischemic stroke patients have a certain risk of concurrent stress disorder after trauma,and are easily affected by stroke patients'personality characteristics,daily living ability,swallowing dysfunction,coping style and social support,etc.Targeted preventive interventions should be developed to reduce the risk of PTSD and improve the prognosis and quality of life.