首发脑卒中患者创伤后应激障碍症状的网络分析及护理对策

doi:10.3761/j.issn.0254-1769.2024.08.009

摘要/Abstract

摘要：

目的通过网络分析模型探究首发脑卒中患者创伤后应激障碍症状网络的核心症状及护理对策，为症状的精准干预与护理提供依据。方法采用横断面研究，便利抽取2022年10月—2023年4月在青岛市某三级甲等综合医院神经内科住院的232例首发脑卒中患者为调查对象，采用修订版创伤后应激障碍症状筛查量表进行调查，应用R软件进行创伤后应激障碍症状网络分析，包括网络关系分析、核心症状分析及网络结构的准确性和稳定性分析。结果症状网络分析显示，症状“高警觉”和“惊跳反应过度”、“回避与创伤事件相关的想法或感觉”和“回避易使人联想起创伤事件的活动或情景”、“负性信念”和“责备自己或怪罪他人”之间的关系最强，正则化偏相关系数分别为0.650、0.635、0.381；症状“与创伤相关的遗忘”的可预测性最高；症状“难以体验积极的情绪”的预期影响最高，该症状与其他症状的连接更紧密。经检验，网络的准确性和稳定性较好，网络模型较为可靠。结论该研究利用症状网络分析法探究首发脑卒中患者创伤后应激障碍的症状网络，针对网络中关系最强及可预测性高的症状，提示临床医护人员在干预过程中要预防性地切断这些症状间的较强连接，提高干预效率；“难以体验积极的情绪”是网络中最核心的症状，提示在未来研究中为提高患者的创伤后应激障碍控制效果，促进心理康复，应将该症状作为干预的靶点，拟订科学的心理干预措施，促进患者心理健康状况的改善。

关键词: 脑卒中, 创伤后应激障碍, 症状网络分析, 核心症状, 护理

Abstract:

Objective This study aims to construct a network of post-traumatic stress disorder（PTSD） symptoms in first stroke patients，to explore the network characteristics and identify core symptom through network analysis，and provide a basis for precise intervention of symptoms. Methods From October 2022 to April 2023，we recruited 232 first stroke patients by using convenience sampling from a tertiary hospital in Qingdao. PTSD checklist for DSM-5 was used to investigate 20 symptoms，construct a symptom network，and analyze the accuracy and stability of core symptom and network structure. Statistical analysis of the network and data visualization were achieved by R software. The test shows that the accuracy and stability of the network are good，and the network model is reliable. Results The PTSD network shows symptoms of "hypervigilance" and "hyperactive startle response"，"avoidance of memories，thoughts，or feelings related to the traumatic event" and "avoidance of external cues related to the traumatic event"，"negative beliefs" and "blaming oneself or others" had the strongest association between these 2 symptoms of all. Their regularized partial correlation coefficients were 0.650，0.635，0.381. The symptom "trauma-related forgetting" had the highest predictability. The expected influence results indicated that the symptom"restriction of positive emotion" had the highest centrality. This symptom was more closely related to other symptoms. Conclusion In this study，symptom network analysis was used to explore the symptom network of PTSD in first stroke patients. According to the symptoms with the strongest relationship and the high predictability value in the results，it is suggested that the strong connection between these symptoms should be cut off preventatively during the intervention process to improve the intervention efficiency. The results of PTSD symptom network show that "restriction of positive emotion" is the most core symptom of PTSD. This suggests that clinical health care personnel should take this symptom as the target point of intervention and use it as a breakthrough point to formulate scientific psychological interventions to effectively improve patients’ mental health，enhance the control effect of PTSD and promote psychological recovery.

Key words: Stroke, Post-Traumatic Stress Disorder, Symptom Network Analysis, Core Symptom, Nursing Care

侯佳雨, 杨丽, 李佳, 吕润田. 首发脑卒中患者创伤后应激障碍症状的网络分析及护理对策[J]. 中华护理杂志, 2024, 59(8): 953-959.

HOU Jiayu, YANG Li, LI Jia, LÜ Runtian. Network analysis and nursing implications of post-traumatic stress disorder symptoms in first stroke patients[J]. Chinese Journal of Nursing, 2024, 59(8): 953-959.

图/表 3

表1 调查对象的一般资料（n=232）

Table 1 Participants characteristics（n=232）

表2 232例首发脑卒中患者修订版创伤后应激障碍症状筛查量表各条目得分（n=232）

Table 2 PTSD checklist for DSM-5 scores in 232 first stroke patients（n=232）

图1 创伤后应激障碍症状网络注：边的粗细代表节点间相关性的强弱，绿色边表示正关联，红色边表示负关联。B1=闯入性的创伤记忆；B2=与创伤相关的噩梦；B3=创伤事件闪回；B4=创伤事件的线索引发情绪反应；B5=创伤事件的线索引发生理反应；C6=回避与创伤事件相关的想法或感觉；C7=回避易使人联想起创伤事件的活动或情景；D8=与创伤相关的遗忘；D9=负性信念；D10=责备自己或怪罪他人；D11=与创伤相关的负性情绪；D12=兴趣减退；D13=疏远他人；D14=难以体验积极的情绪；E15=烦躁易怒；E16=自伤行为；E17=高警觉；E18=惊跳反应过度；E19=注意力难以集中；E20=睡眠问题。

Figure 1 Network of post-traumatic stress disorder symptoms

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