非创伤脓毒症幸存康复病人急性应激障碍的危险因素分析  

Risk factors of acute stress disorder in survivors of non-trauma associated sepsis

作　　者：李娟[1] 张志坚[2] 田黎[1] 彭礼波 LI Juan;ZHANG Zhijian;TIAN Li;PENG Libo(Department of Infectious Diseases,People’s Hospital of Ba’nan District,Chongqing 401320,China;Department of Critical Care Medicine,People’s Hospital of Ba’nan District,Chongqing 401320,China)

机构地区：[1]重庆市巴南区人民医院感染性疾病科,重庆401320 [2]重庆市巴南区人民医院重症医学科,重庆401320

出　　处：《安徽医药》2021年第2期276-279,共4页Anhui Medical and Pharmaceutical Journal

基　　金：重庆市卫生和计划生育委员会项目(2017ZBXM023,ZY201703036);重庆市巴南区社会事业科技计划项目(2016-6)。

摘　　要：目的探讨非创伤脓毒症幸存康复病人急性应激障碍(ASD)的危险因素。方法选择2017年1月至2019年1月重庆市巴南区人民医院收治的非创伤脓毒症幸存康复病人512例,使用斯坦福急性应激反应问卷(SASRQ)对病人进行ASD评定,同时记录病人的临床资料及治疗情况,分析非创伤脓毒症病人ASD的危险因素。结果根据SASRQ评估,符合DSM-Ⅳ诊断标准,本组病人中81例合并ASD,发生率为15.82%。ASD组病人序贯器官衰竭评估(SOFA)评分≥6分、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分≥15分、急性呼吸窘迫综合征(ARDS)、急性肾损伤(AKI)、有创机械通气、血液净化、住ICU、院内感染、阿片类镇痛药及苯二氮?类镇静剂使用病人均高于非ASD病人,差异有统计学意义(χ^2值分别为122.543、101.388、61.172、57.539、107.416、21.429、67.314、16.394、33.638、64.721,P<0.001)。Logistic回归分析显示,APACHEⅡ评分≥15分(OR=5.432,95%CI:1.033~25.497)、SOFA评分≥6分(OR=7.479,95%CI:1.345~31.451)、有创机械通气(OR=19.173,95%CI6.302~51.183)、住ICU(OR=16.545,95%CI:2.739~41.258)是非创伤脓毒症病人ASD的独立危险因素。结论APACHEⅡ评分≥15分、SOFA评分≥6分、有创机械通气及入住ICU是非创伤性脓毒症病人急性应激障碍的独立危险因素。Objective To explore the risk factors of acute stress disorder(ASD)in survivors of non-trauma associated sepsis.Methods A total of 512 patients with non-trauma associated sepsis admitted to People’s Hospital of Ba’nan District of Chongqing from January 2017 to January 2019 were enrolled in this study.All subjects were assessed on ASD with Stanford acute stress reaction questionnaire(SASRQ),and the clinical data and treatment status during hospitalization were collected to analyze the risk factors of ASD.Results According to the score of SASRQ,compliance with DSM-Ⅳdiagnostic criteria,81 cases were complicated with ASD,with an incidence rate of 15.82%.There were more ASD patients with Sequential Organ Failure Assessment(SOFA)score≥6,Acute Physiology and Chronic Health Evaluation Scoring SystemⅡ(APACHEⅡ)score≥15,acute respiratory distress syndrome(ARDS),acute kidney injury(AKI),invasive mechanical ventilation,continuous hemofiltration,ICU admission,nosocomial infections,use of opioid analgesics and benzodiazepam were than non-ASD patients.The differences were statistically significant(χ^2=122.543,101.388,61.172,57.539,107.416,21.429,67.314,16.394,33.638,64.721,P<0.001).Logistic regression analysis showed that APACHEⅡscore≥15(OR=5.432,95%CI:1.033~25.497),SOFA score≥6(OR=7.479,95%CI:1.345~31.451),invasive mechanical ventilation(OR=19.173,95%CI:6.302~51.183),and ICU admission(OR=16.545,95%CI:2.739~41.258)were independent risk factors for ASD.Conclusion APACHEⅡscore)15,SOFA score≥6,invasive mechanical ventilation and ICU admission were independent risk factors for ASD among patients with non-trauma associated sepsis.

关 键 词：脓毒症 非创伤性 急性应激障碍 危险因素 斯坦福急性应激反应问卷 

分 类 号：R459.7[医药卫生—急诊医学] R749.5[医药卫生—治疗学]