疾病严重程度与ICU清醒危重患者心理状态关系的多中心研究  

Relationship between severity of illness and mental status in ICU conscious patients： a nationwide multi-center clinical study

作　　者：王宇[1] 马朋林[1] 刘京涛[1] 苏瑾文[1] 李秦[1] 曾琳[2] 

机构地区：[1]解放军总医院第二附属医院急救部,北京100091 [2]北京大学第三医院统计教研室

出　　处：《中华医学杂志》2008年第21期1450-1453,共4页National Medical Journal of China

基　　金：中国病理生理学会危重病专业委员会与欧洲危重病学会合作资助项目（Health-2007-3.1-3：patient safety research）

摘　　要：目的多中心调查清醒危重患者ICU住院期间心理不良事件，并分析与疾病严重程度的关系。方法选择全国31个ICU进行为期2个月连续性调查。所有转出ICU的清醒患者均入选本次调查，于转出后2d内，由上海诺德健康咨询公司访问员按问卷要求对患者进行独立访问。结果共计234例患者接受调查，其中163例（69．6％）发生心理不良事件。多因素Logistic回归分析发现，APACHEⅡ评分是患者发生心理不良事件的独立危险因素（OR=1．07，95％CI：1．02—1．13，P〈0．05），而与患者年龄、性别以及ICU住院天数无密切关系。患者APACHEⅡ评分在1-10、11-20以及〉20的3个不同区间内，发生心理不良事件的相对危险度（RR）分别为1．29、2．53和4．85（P〈0．05）。APACHEⅡ评分越高，接受有创监测和治疗项目数越多（P〈0．01），耐受噪音以及医疗护理操作的阈值越低，发生心理不良事件的危险度越高（P〈0．01）。结论APACHEⅡ评分是诱发不良心理事件的独立危险因素。APACHEⅡ评分高的ICU清醒患者接受有创监测和治疗项目数多，以及心理应激阈值降低是诱发心理不良事件的重要原因。Objective To survey the incidence of psychological adverse events in critical conscious patients during their ICU stay and analyze the relationship between the incidence and the severity of illness. Methods 234 conscious patients, 133 males and 101 females, aged （55.4 ± 19.6）, 80 with internal medicine diseases and 154 with surgical diseases, were treated in the ICUs of 31 grade 3 A hospitals over the country consecutively during the period of 2 months and then successfully transferred to other departments. The patients were interviewed with specific questionnaire within the 2 days after transfer to investigate the incidence of anxiety and depression and the tolerance of invasive medical and nursing procedures of the patients. Results The overall incidence of psychological adverse events （PAE） was 69.6%. Multi-variate Logistic analysis showed that acute physiology and chronic health evaluation （APACHE） Ⅱ score was an independent high risk factor of PAE （ OR = 1.07, 95% CI ： 1.02-1.13, P 〈 0.05）. The relative risk （RR） values of the patients with APACHE Ⅱ scores 1 - 10, 11 - 20, and 〉 20 were 1.29, 2.53, and 4.85 respectively. The higher the APACHE Ⅱ score, the more invasive interventions received（ P 〈 0.01 ）, and the lower the mental stress threshold （ P 〈 0.01 ） the higher the incidence of PAE （ P 〈 0.01 ）. The APACHE Ⅱ scores of those who failed to tolerate noise and medical and nursing procedures were 15.8 ± 5.7 and 16.5 ± 6.1 respectively, both significantly higher than those of the patients who tolerated （12.1 ± 4.4, P 〈 0.05; and 10.6 ± 2.9, P 〈 0.01 ）. Conclusion APACHE Ⅱ score is an independent high risk factor of PAE. The conscious ICU patients with higher APACHE Ⅱ scores receive more invasive medical and nursing procedures. Low mental stress threshold greatly contributed to the incidence of PAE in ICU conscious critical patients with high APACHE Ⅱ score.

关 键 词：危重病人医疗 危重病 心理学 临床 APACHEⅡ评分 

分 类 号：R686[医药卫生—骨科学]