断指再植患者创伤后应激障碍的潜在剖面分析及影响因素研究

Latent profile analysis and influencing factors of post-traumatic stress disorder in patients undergoing replantationof severedfingers

目的探讨断指再植患者创伤后应激障碍(PTSD)的潜在分型, 并分析不同PTSD分型的影响因素。方法 2022年1月-2023年12月, 采用方便抽样法选取在浙江省台州医院手足外科接受断指再植的335例患者为研究对象。采用一般资料调查表、创伤后应激障碍量表-平民版、事件相关性反刍性沉思量表、中文版领悟社会支持量表和艾森克人格问卷简式量表进行调查。采用潜在剖面分析探讨断指再植患者PTSD的潜在类别, 并采用有序Logistic回归分析探究断指再植患者PTSD分型的影响因素。结果共发放问卷335份, 回收有效问卷328份, 有效回收率为97.91%。潜在剖面分析结果显示, 328例断指再植患者PTSD可分为3个潜类别:低创伤后应激障碍-高回避型(n=67, 占20.43%)、中创伤后应激障碍-高警觉型(n=178, 占54.27%)、高创伤后应激障碍-高警觉型(n=83, 占25.30%)。不同分型的断肢再植患者断指数量、术后血管危象发生情况、反刍性沉思、领悟社会支持和人格特质得分差异均有统计学意义(P<0.05)。以低创伤后应激障碍-高回避型为参照, 有序Logistic回归分析显示, 侵入性反刍、目的性反刍、人格类型(内外向性、神经质、精神质)是中创伤后应激障碍-高警觉型潜在剖面的影响因素(P<0.05);断指数量、术后发生血管危象、侵入性反刍、目的性反刍、领悟社会支持、人格类型(内外向性、神经质、精神质)是高创伤后应激障碍-高警觉型潜在剖面的影响因素(P<0.05)。结论断指再植患者PTSD存在明显的群体异质性, 可分为"低创伤后应激障碍-高回避型""中创伤后应激障碍-高警觉型""高创伤后应激障碍-高警觉型"。护理人员应结合断指数量、术后是否发生血管危象、反刍性沉思水平、人格类型等影响因素早期进行针对性干预, 预防和改善PTSD发生。

Objective To explore the potential categories of post-traumatic stress disorder(PTSD)in patients undergoing replantation of severed fingers,and analyze their influencing factors.Methods From January 2022 to December 2023,convenience sampling was used to select 335 patients who underwent replantation of severed fingers at the Hand and Foot Surgery of Taizhou Hospital of Zhejiang Province as research subjects.The survey was conducted using the General Information Questionnaire,PTSD Checklist-Civilian Version,Event Related Rumination Inventory,Chinese version of the Perceived Social Support Scale,and the Eysenck Personality Questionnaire-Revised,Short Scale for Chinese.Potential profile analysis was used to explore the potential categories of PTSD in patients undergoing replantation of severed fingers,and ordered Logistic regression was used to analyze the influencing factors of PTSD categories.Results A total of 335 questionnaires were distributed,and 328 valid questionnaires were collected,with a valid response rate of 97.91%.Potential profile analysis showed that PTSD of 328 patients undergoing severed finger replantation were divided into three latent categories,including low PTSD-high avoidance type(n=67,accounting for 20.43%),moderate PTSD-high alertness type(n=178,accounting for 54.27%),and high PTSD-high alertness type(n=83,accounting for 25.30%).There were statistically significant differences in the number of severed fingers,incidence of postoperative vascular crisis,rumination,perceived social support,and personality trait scores among patients with different types of severed finger replantation(P<0.05).Taking low PTSD-high avoidance type as a reference,ordered Logistic regression analysis showed that invasive rumination,purposive rumination,and personality types(introversion,neuroticism,psychoticism)were potential influencing factors for the moderate PTSD-high alertness type(P<0.05).The number of severed fingers,postoperative vascular crisis,invasive rumination,purposive rumination,perceived social support,and personality type(introversion,neuroticism,psychoticism)were potential influencing factors of high PTSD-high alertness type(P<0.05).Conclusions There is significant population heterogeneity in PTSD among patients undergoing severed finger replantation,which can be divided into"low PTSD-high avoidance type","moderate PTSD-high alertness type",and"high PTSD-high alertness type".Nursing staff should conduct targeted interventions in the early stage based on factors such as the number of severed fingers,whether vascular crisis occurs after operation,level of rumination,personality type,to prevent and improve the occurrence of PTSD.