ICU患者创伤心理反应的潜在剖面及影响因素的混合研究

doi:10.3761/j.issn.0254-1769.2025.07.012

摘要/Abstract

摘要：

目的探讨ICU患者创伤心理反应的潜在类别特征，并分析不同潜在类别的影响因素，以期为实施个性化干预提供参考。方法便利选取2023年5月—2024年2月于某三级综合医院ICU治疗的300例患者为调查对象，使用一般资料调查表、社会支持评定量表、心理弹性简表、中文版急性应激障碍量表与简体中文版创伤后成长评定量表进行调查，并采用多元Logistic回归分析进行数据分析；采用目的抽样法对12例ICU患者进行半结构化访谈，并使用解释现象学分析方法对访谈资料进行分析。结果 ICU患者创伤心理反应可分为创伤寄居型（17.3%）、平稳过渡型（36.0%）、外援生长型（25.3%）与内生扎根型（21.3%）4个潜在类别。年龄、学历、社会支持水平、心理弹性、家庭人均月收入与使用激素药种类数是ICU患者创伤心理反应的影响因素（P<0.05）。质性研究结果共提炼出4个核心主题，包括沉溺于心理创伤、理性认知并接纳现实、借助外力尝试自我成长、反刍沉思并重塑心境，分析出年龄、收入、有无重大疾病/ICU治疗史、疾病认知程度、有无未成年子女及个体反刍性沉思力等ICU患者创伤心理反应的影响因素。量性与质性研究结果相互验证与互为补充。结论 ICU患者急性应激反应明显，其创伤心理反应潜在类别存在多元特征，提示医护人员可通过早期识别各类别特征及影响因素，制订个性化干预方案，促进其创伤后成长。

关键词: 潜在剖面分析, 重症监护病房, 创伤后成长, 急性应激障碍, 混合研究, 护理

Abstract:

Objective To explore the characteristics of the potential categories of traumatic psychological reactions in ICU patients and analyze the influencing factors of different potential categories，in order to provide ideas for the implementation of scientific and effective personalized intervention in the future. Methods A convenience sample of 300 patients treated in the ICU of a hospital from May 2023 to February 2024 was surveyed. The used instruments included a general information questionnaire，the Social Support Rating Scale，the Brief Resilience Scale，the Acute Stress Disorder Scale，and the Simplified Chinese version of the Post-Traumatic Growth Inventory. Data were analyzed using multivariate Logistic regression. Additionally，a purposive sampling method was used to conduct semi-structured interviews with 12 ICU patients，and the interview data were analyzed by interpretative phenomenological analysis. Results Quantitative research results showed that the traumatic psychological responses of ICU patients were categorized into 4 latent classes，including Trauma-Dependent Type（17.3%），Smooth-Transition Type（36.0%），External-Support Growth Type（25.3%），and Internal-Rooted Growth Type（21.3%）. Factors influencing these responses included age，educational level，social support，psychological resilience，household income，and the number of used hormone medications（P<0.05）. Qualitative research results showed that 4 core themes were identified，including immersion in psychological trauma，rational cognition and acceptance of reality，seeking external support for personal growth，and independent exploration of inner self. Influencing factors included age，income level，history of major illness or ICU treatment，level of disease awareness，presence of underage children，and individual capacity for rumination. The quantitative and qualitative results were mutually corroborative and complemented each other. Conclusion The acute stress response of ICU patients is obvious，and there are multiple characteristics in the potential categories of traumatic psychological response，suggesting that medical and nursing staff can identify the characteristics of various types and influencing factors early，formulate personalized intervention programs，and promote their post-traumatic growth.

Key words: Latent Profile Analysis, Intersive Care Unit, Post-Traumatic Growth, Acute Stress Disorder, Mixed Studies, Nursing Care

李红颐, 李雪, 范宇莹, 赵一莎, 李京淑. ICU患者创伤心理反应的潜在剖面及影响因素的混合研究[J]. 中华护理杂志, 2025, 60(7): 842-848.

LI Hongyi, LI Xue, FAN Yuying, ZHAO Yisha, LI Jingshu. A mixed study of latent profile analysis and influencing factors of psychological responses to trauma in ICU patients[J]. Chinese Journal of Nursing, 2025, 60(7): 842-848.

图/表 4

图1 ICU患者创伤心理反应潜在剖面的特征分布图

Figure 1 Characteristic distribution map of the latent profile of psychological responses to trauma in ICU patients

表1 ICU患者创伤心理反应潜在剖面的多因素分析（n=300）

Table 1 Multivariate analysis of the latent profile of trauma response in ICU patients（n=300）

表2 受访者一般资料（n=12）

Table 2 General information of respondents（n=12）

表3 混合研究整合结果

Table 3 Integrated results of mixed studies

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