中华护理杂志 ›› 2023, Vol. 58 ›› Issue (18): 2223-2229.DOI: 10.3761/j.issn.0254-1769.2023.18.007
程志强(), 张宝珍(
), 夏娇云, 李夏欣, 严宪峰, 周钰珏, 闫程坤, 付焕旭
收稿日期:
2023-05-07
出版日期:
2023-09-20
发布日期:
2023-09-22
通讯作者:
张宝珍,E-mail:784243416@qq.com作者简介:
程志强:本科(硕士在读),主管护师,E-mail:770808254@qq.com
基金资助:
CHENG Zhiqiang(), ZHANG Baozhen(
), XIA Jiaoyun, LI Xiaxin, YAN Xianfeng, ZHOU Yujue, YAN Chengkun, FU Huanxu
Received:
2023-05-07
Online:
2023-09-20
Published:
2023-09-22
摘要:
目的 构建ICU转出患者应激障碍(post-traumatic stress disorder,PTSD)风险预测模型,并进行内外部验证。 方法 采用便利抽样法,于2022年10月至2023年5月选取江西省2所三级甲等医院514例ICU患者为调查对象。通过单因素和Logistic回归分析确定危险因素并构建预测模型。通过受试者工作特征(receiver operating characteristic,ROC)曲线下面积和Hosmer-Leme-show检验评价预测模型的区分度和校准度,临床决策曲线评价预测模型的临床有效性。 结果 ICU转出患者PTSD的影响因素为性别、心理疾病史、镇静剂、机械通气史、ICU住院时间、妄想记忆。预测模型为Logit P=性别 × 1.366+心理疾病史 × 1.221+镇静剂 × 1.018+机械通气史 × 1.378+ICU住院时间 × 0.546+妄想记忆 × 0.929-6.793。ROC曲线下面积为0.898(95%CI 0.865~0.932),灵敏度为82.9%,特异度为83.2%,最大约登指数为0.661,临界值为0.393,临界分数为60分。Hosmer-Leme-show检验显示,χ2=11.312,P=0.185。内外部验证显示,ROC曲线下面积分别为0.855、0.867。校准曲线显示观察曲线与预测曲线拟合良好,模型校准度较好。临床决策曲线显示该模型有良好的临床有效性。 结论 该研究构建的预测模型具有较好的预测效能,能够为临床医护人员早期识别ICU转出患者发生PTSD的高危人群和进行及时干预提供理论依据。
程志强, 张宝珍, 夏娇云, 李夏欣, 严宪峰, 周钰珏, 闫程坤, 付焕旭. ICU转出患者应激障碍风险预测模型的构建与验证[J]. 中华护理杂志, 2023, 58(18): 2223-2229.
CHENG Zhiqiang, ZHANG Baozhen, XIA Jiaoyun, LI Xiaxin, YAN Xianfeng, ZHOU Yujue, YAN Chengkun, FU Huanxu. Development and validation of risk prediction model for post-traumatic stress disorder in ICU transferred patients[J]. Chinese Journal of Nursing, 2023, 58(18): 2223-2229.
[1] |
Righy C, Rosa RG, da Silva RTA, et al. Prevalence of post-trau-matic stress disorder symptoms in adult critical care survi-vors:a systematic review and meta-analysis[J]. Crit Care, 2019, 23(1):213.
DOI |
[2] | 刘晓军, 现代精神疾病诊疗新进展[M]. 2版. 长春: 吉林科学技术出版社, 2019. |
Liu XJ. New progress in diagnosis and treatment of modern mental diseases[M]. 2nd ed. Changchun: Jilin Science & Technology Publishing House, 2019. | |
[3] |
Franks ZM, Alcock JA, Lam T, et al. Physical restraints and post-traumatic stress disorder in survivors of critical illness. A systematic review and meta-analysis[J]. Ann Am Thorac Soc, 2021, 18(4):689-697.
DOI PMID |
[4] |
杜羿霏, 钟月欢, 包旭平, 等. ICU转出患者心理障碍风险预测工具的范围综述[J]. 中华护理杂志, 2022, 57(3):284-289.
DOI URL |
Du YF, Zhong YH, Bao XP, et al. Instruments for predicting the risk of psychological disorder of ICU discharged patients:a scoping review[J]. Chin J Nurs, 2022, 57(3):284-289. | |
[5] | 邵勤文, 孙向红, 赵海平. ICU后综合征心理功能障碍的研究进展[J]. 护士进修杂志, 2021, 36(6):525-529. |
Shao QW, Sun XH, Zhao HP. Research progress on psychological dysfunction of post-ICU syndrome[J]. J Nurses Train, 2021, 36(6):525-529. | |
[6] |
孟萌, 关玉珠, 郭利敏, 等. 心血管外科术后患者ICU后综合征风险预测模型的构建及验证[J]. 中华护理杂志, 2022, 57(12):1486-1494.
DOI URL |
Meng M, Guan YZ, Guo LM, et al. Construction of a risk predic-tion model for patients with post-intensive care syndrome after cardiovascular surgery and its prediction effect[J]. Chin J Nurs, 2022, 57(12):1486-1494. | |
[7] |
Calsavara AJ, Costa PA, Nobre V, et al. Prevalence and risk factors for post-traumatic stress,anxiety,and depression in sepsis survivors after ICU discharge[J]. Braz J Psychiatry, 2021, 43(3):269-276.
DOI URL |
[8] |
魏月清, 李红, 李芸, 等. ICU后认知障碍风险预测模型的构建及验证[J]. 中华护理杂志, 2021, 56(1):14-20.
DOI |
Wei YQ, Li H, Li Y, et al. Construction of a risk prediction model for post-intensive care syndrome-cognitive impairment[J]. Chin J Nurs, 2021, 56(01):14-20. | |
[9] |
Zimet GD, Dahlem NW, Zimet SG, et al. The multidimensional scale of perceived social support[J]. J Pers Assess, 1988, 52(1):30-41.
DOI URL |
[10] | 姜乾金. 领悟社会支持量表[J]. 中国行为医学科学, 2001, 10(10):41-43. |
Jiang QJ. Understanding Social Support Scale[J]. Chin J Behav Med Sci, 2001, 10 (10):41-43. | |
[11] | Weiss DS, Marmar CR. The Impact of Event Scale-Revised[M]. New York: Assessing Psychological Trauma and PTSD, 1997:399-411. |
[12] | 郭素然, 辛自强, 耿柳娜. 事件影响量表修订版的信度和效度分析[J]. 中国临床心理学杂志, 2007, 15(1):15-17. |
Guo SR, Xin ZQ, Geng LN. Reliability and validity of Chinese version of the Impact of Event Scale-Revised[J]. Chin J Clin Psychol, 2007, 15(1):15-17. | |
[13] |
刘颖, 陈佳丽, 宁宁, 等. 骨肿瘤手术患者创伤后成长的调查研究[J]. 中华护理杂志, 2022, 57(10):1184-1190.
DOI URL |
Liu Y, Chen JL, Ning N, et al. Study on the relationship be-tween post-traumatic stress and post-traumatic growth in pa-tients with bone neoplasms surgery[J]. Chin J Nurs, 2022, 57(10):1184-1190. | |
[14] |
Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale[J]. Acta Psychiatr Scand, 1983, 67(6):361-370.
DOI URL |
[15] | 孙振晓, 刘化学, 焦林瑛, 等. 医院焦虑抑郁量表的信度及效度研究[J]. 中华临床医师杂志(电子版), 2017, 11(2):198-201. |
Sun ZX, Liu HX, Jiao LY, et al. A study on the reliability and validity of the Hospital Anxiety and Depression Scale[J]. Chin J Clinical Physicians(Elect Ed), 2017, 11(2):198-201. | |
[16] |
Jones C, Humphris G, Griffiths RD. Preliminary validation of the ICUM tool:a tool for assessing memory of the intensive care experience[J]. Clin Intensive Care, 2000, 11(5):251-255.
DOI URL |
[17] | 黄丽, 江琴, 林秀霞, 等. ICU记忆评估工具的汉化和ICU记忆量表的信效度检验[J]. 中华护理杂志, 2016, 51(10):1265-1269. |
Huang L, Jiang Q, Lin XX, et al. Reliability and validity of the Chinese version of Intensive Care Unit Memory Tool[J]. Chin J Nurs, 2016, 51(10):1265-1269. | |
[18] |
Vickers AJ, Holland F. Decision curve analysis to evaluate the clinical benefit of prediction models[J]. Spine J, 2021, 21(10):1643-1648.
DOI PMID |
[19] |
Hatch R, Young D, Barber V, et al. Anxiety,Depression and Post Traumatic Stress Disorder after critical illness:a UK-wide prospective cohort study[J]. Crit Care, 2018, 22(1):310.
DOI |
[20] | 蔡阿燕, 杨洁敏, 许爽, 等. 表达抑制调节负性情绪的男性优势:来自事件相关电位的证据[J]. 心理学报, 2016, 48(5):482-494. |
Cai AY, Yang JM, Xu S, et al. The male advantage in regula-ting negative emotion by expressive suppression:an event-related potential study[J]. Acta Psychol Sin, 2016, 48(5):482-494.
DOI URL |
|
[21] | 王烁. ICU患者创伤后应激障碍危险因素与非药物干预的研究[D]. 福州: 福建医科大学, 2017. |
Wang S. Study on risk factors and non-drug intervention of post-traumatic stress disorder in ICU patients[D]. Fuzhou: Fujian Medical University, 2017. | |
[22] |
Oud L, Garza J. Impact of history of mental disorders on short-term mortality among hospitalized patients with sepsis:a population-based cohort study[J]. PLoS One, 2022, 17(3):e0265240.
DOI URL |
[23] | 黄丽, 罗利, 胡蓉芳. ICU相关记忆及其影响因素的研究[J]. 护理学杂志, 2015, 30(24):70-73. |
Huang L, Luo L, Hu RF. Study on memories from the intensive care unit and the influencing factors[J]. J Nurs Sci, 2015, 30(24):70-73. | |
[24] |
Brady ML, Pilli J, Lorenz-Guertin JM, et al. Depolarizing,in-hibitory GABA type A receptor activity regulates GABA ergic synapse plasticity via ERK and BDNF signaling[J]. Neuropharmacology, 2018, 128:324-339.
DOI URL |
[25] |
Huang X, Lin DD, Sun Y, et al. Effect of dexmedetomidine on postoperative sleep quality:a systematic review[J]. Drug Des Devel Ther, 2021, 15:2161-2170.
DOI URL |
[26] |
Kotfis K, van Diem-Zaal I, Williams Roberson S, et al. The future of intensive care:delirium should no longer be an issue[J]. Crit Care, 2022, 26(1):200.
DOI |
[27] | 李荣华, 黄敬烨, 刘晓青, 等. ICU机械通气存活者不同时期心理功能状况的纵向研究[J]. 实用医学杂志, 2020, 36(11):1531-1536. |
Li RH, Huang JY, Liu XQ, et al. Longitudinal study of psychological function in the mechanical ventilated survivors of ICU[J]. The J Prac Med, 2020, 36(11):1531-1536. | |
[28] |
Wade DM, Howell DC, Weinman JA, et al. Investigating risk factors for psychological morbidity three months after intensive care:a prospective cohort study[J]. Crit Care, 2012, 16(5):R192.
DOI URL |
[29] |
Karanikola M, Alexandrou G, Mpouzika M, et al. Pilot explora-tion of post-traumatic stress symptoms in intensive care unit survivors in Cyprus[J]. Nurs Crit Care, 2021, 26(2):109-117.
DOI PMID |
[30] | 黄庆萍, 黄艳芳, 罗芳梅, 等. 危重患者ICU后综合征发生抑郁障碍的相关危险因素分析[J]. 中国医学创新, 2019, 16(26):154-158. |
Huang QP, Huang YF, Luo FM, et al. Analysis of risk factors associated with depressive disorder in post-intensive care syndrome patient[J]. Med Innovation Chin, 2019, 16(26):154-158. | |
[31] |
Nikayin S, Rabiee A, Hashem MD, et al. Anxiety symptoms in survivors of critical illness:a systematic review and meta-analysis[J]. Gen Hosp Psychiatry, 2016, 43:23-29.
DOI URL |
[32] | Svenningsen H, Egerod I, Christensen D, et al. Symptoms of posttraumatic stress after intensive care delirium[J]. Biomed Res Int, 2015, 2015:876947. |
[33] |
杜晓菊, 张海林, 尹丽霞, 等. 维持性血液透析患者骨骼肌质量下降预测模型的构建及对护理工作的启示[J]. 中华护理杂志, 2021, 56(4):496-501.
DOI URL |
Du XJ, Zhang HL, Yin LX, et al. Establishment and enlightenment of a predictive model for decreased skeletal muscle mass in maintenance hemodialysis patients[J]. Chin J Nurs, 2021, 56(4):496-501.
DOI URL |
|
[34] |
Sanchez-Santos MT, Williamson E, Nicolson PJA, et al. Development and validation of a prediction model for self-reported mobility decline in community-dwelling older adults[J]. J Clin Epidemiol, 2022, 152:70-79.
DOI PMID |
[1] | 顾婕, 马倩云, 高旭, 李惠珍, 孟晓红, 谢双怡, 樊帆, 周意, 曹洁. 前列腺癌术后尿失禁患者康复护理方案的构建及应用[J]. 中华护理杂志, 2023, 58(9): 1029-1036. |
[2] | 薛瑾, 王清, 蒋玲, 程念开, 黄琴, 倪兴梅, 顾肖, 陈怡雷, 夏莲子. ICU患者谵妄管理临床决策支持系统的构建与应用研究[J]. 中华护理杂志, 2023, 58(9): 1037-1042. |
[3] | 方园, 周英凤, 李丽, 邢年路, 陈姝宇, 王娜, 阴传敏. 妊娠期糖尿病非药物管理决策支持系统的构建及应用[J]. 中华护理杂志, 2023, 58(9): 1043-1049. |
[4] | 夏艳玲, 潘文彦, 赵洋洋, 陈志炜, 蔡诗凝, 唐颖嘉, 金喆. 虚拟现实技术在ICU患者早期活动中的应用研究[J]. 中华护理杂志, 2023, 58(9): 1050-1055. |
[5] | 雒晓燕, 崔仁善, 许秀梅, 崔苗苗, 郭玲茹, 周丹. 基于“互联网+”的护理干预对癌症患者疼痛影响的Meta分析[J]. 中华护理杂志, 2023, 58(9): 1056-1062. |
[6] | 徐雪芬, 王红燕, 郭萍萍, 王宇璐, 冯素文. 人工智能在慢性病患者健康管理中的应用进展[J]. 中华护理杂志, 2023, 58(9): 1063-1067. |
[7] | 刘洋, 黄浠婷, 蒋智丽, 王智乾, 陶国芳, 邢美园, 黄丽华. 基于说服系统构建慢性病患者自我管理信息系统的范围综述[J]. 中华护理杂志, 2023, 58(9): 1068-1075. |
[8] | 倪秀梅, 徐凤玲, 陈浩, 宫娟, 章翀, 王翠, 李宝芹, 胡少华. 基于肺部超声的气道廓清方案在ICU机械通气患者中的应用[J]. 中华护理杂志, 2023, 58(9): 1076-1081. |
[9] | 相爽, 王宾, 苗华, 韩荆, 姜京京, 郑文, 严研, 王晓, 公威, 艾辉, 阙斌, 聂绍平, 张立新. 急性冠脉综合征住院患者跌倒风险评估及影响因素分析[J]. 中华护理杂志, 2023, 58(9): 1082-1087. |
[10] | 黄珂瑶, 丁思妍, 周海琴, 蔡英华. 肺移植患者衰弱变化轨迹及影响因素研究[J]. 中华护理杂志, 2023, 58(9): 1088-1095. |
[11] | 黄浩, 焦雨晨, 嵇艳. 三级综合医院急诊科护士置信职业行为指标的构建与验证[J]. 中华护理杂志, 2023, 58(9): 1096-1103. |
[12] | 陈芳, 江智霞, 杨明静, 罗倩, 张霞. 贵州省ICU护理人员对机械通气患者口渴认知及干预行为的调查研究[J]. 中华护理杂志, 2023, 58(9): 1104-1111. |
[13] | 张琦, 陈丽艳, 李媛媛, 张爱华, 杨丽娟. 非创伤性下肢截肢患者生活体验质性研究的Meta整合[J]. 中华护理杂志, 2023, 58(9): 1112-1119. |
[14] | 王利秀, 李建芳, 程红霞, 罗彦, 杨冰香, 刘茜. 造血干细胞移植并发移植物抗宿主病患者皮肤护理的最佳证据总结[J]. 中华护理杂志, 2023, 58(9): 1120-1126. |
[15] | 张若林, 楼妍, 吴婉英, 王春兰, 傅丽英, 周瑶, 洪美容, 徐毓露, 冯欣悦. 癌症患者照顾者角色过渡体验质性研究的Meta整合[J]. 中华护理杂志, 2023, 58(9): 1127-1134. |
阅读次数 | ||||||
全文 |
|
|||||
摘要 |
|
|||||