【评论】炎症性肠病患者的住院经历和创伤后应激:改变的机会

[Comment]Hospitalization experiences and post-traumatic stress in inflammatory bowel disease:opportunities for change

引言与IBD相关的医疗创伤(medical trauma related to IBD,IBD-PTS)影响着约25%的患者,而且与不良预后相关。先前的研究将IBD患者普遍存在的住院经历认定为潜在的创伤,但是未对其与IBD-PTS的风险关系进行评估。我们旨在探究住院经历中可能会增加医疗创伤和IBD-PTS发生率的具体表现。方法研究纳入了IBD合作(IBD Partners)数据库中的成年IBD患者,特定的研究相关问卷包括第5版创伤后应激障碍(post-traumatic stress disorder,PTSD)筛查量表(PCL-5)、患者经历问卷,以及患者精神压力最大的住院和非住院医疗创伤起因条目。PCL-5的既定标准明确了重要的IBD-PTS症状(创伤再体验、回避心理、心境变化、过度唤起、整体诊断结果)。选择性的疾病信息和治疗信息来自于重要的IBD合作数据库数据集。单变量和多变量统计方法被用于评估住院经历数据与IBD-PTS之间的关系。结果共纳入639例因IBD存在至少一次住院经历的患者。约三分之二的患者罹患克罗恩病;大多为白人、非西班牙裔、女性、中年和处于IBD缓解期的患者。40%的患者表示住院经历是IBD-PTS的起因之一。住院期间频繁出现的焦虑会使IBD-PTS发生率增加2~4倍,疼痛/疼痛控制效果也呈现类似的关系。来自医护人员更高质量的沟通交流、信息告知和倾听技巧可以降低IBD-PTS的发生率,尽管作用很有限。结论IBD患者普遍认为住院经历是医疗创伤的潜在起因,焦虑和疼痛处理不当最有可能导致IBD-PTS的发生,不同性别和种族/民族患者的风险存在差异。患者与医护人员的积极互动有助于减轻住院期间的IBD-PTS。

Introduction Medical trauma related to IBD(IBD-PTS)affects approximately 25%of patients and is associated with poor outcomes.Prior studies identify common hospitalization experiences as potentially traumatic but have not measured risk relationships for the development of IBD-PTS.We aim to investigate what aspects of hospitalizations may increase the chance of medical trauma and IBD-PTS development.Methods Adult patients with IBD enrolled in the IBD Partners database were recruited.Study specific questionnaires included PTSD checklist,5th edition(PCL-5),patient experience questionnaire,and items about the patient's most stressful hospitalization and nonhospital sources of medical trauma.Established criteria for the PCL-5 identified significant IBD-PTS symptoms(re-experiencing,avoidance,mood change,hyperarousal,global diagnosis).Select disease and treatment information was obtained from the main IBD Partners dataset.Univariate and multivariate statistics evaluated the relationships between hospitalization data and IBD-PTS.Results There were 639 participants with at least 1 hospitalization for IBD included.Approximately two-thirds had Crohn's disease;most were White,non-Hispanic,female,middle-aged,and reported their IBD as being in remission.Forty percent of patients stated a hospitalization was a source of IBD-PTS.Frequent anxiety while hospitalized increased the odds of IBD-PTS 2 to 4 times;similar relationships existed for pain/pain control.Higher quality communication,information,and listening skills reduced the odds of IBD-PTS,albeit marginally.Conclusions Patients with IBD consistently cite hospitalizations as potential sources of medical trauma.Poorly managed anxiety and pain demonstrate the greatest chance for IBD-PTS development.Gender and racial/ethnic differences emerged for these risks.Positive interactions with the medical team may help mitigate in-hospital IBD-PTS development.