翁小娟 陈礼贤 吴福斌

[摘要] 目的 了解綜合医院自杀未遂患者的精神科会诊状况。 方法 以2017年1月1日～2019年8月31日期间温岭和玉环两家综合性医院收治的以过量服药或服农药自杀未遂住院患者为研究对象，试图了解自毒自杀未遂患者精神科会诊情况及影响因素。 结果 本次调查共280例自毒患者纳入研究，男148例，女132例，自毒人群集中于中老年人群，平均年龄（49.3±20.5）岁，只有40%患者报告有精神心理疾病史，144例患者在入院时被接诊医生询问自毒原因，住院期间请精神科会诊的有45例，占16.1%;出院时提示院外精神科门诊随诊的有62例;所有患者出院后1个月内到精神科随诊的有45例，占总调查人群的16.1%。相比较而言，有既往相关病史或入院时被询问自毒原因更可能得到精神科会诊，且差异有显著性（P<0.05）;有既往相关病史或住院期间精神科会诊或出院被提示精神科随诊的患者更可能出院后到精神科就诊，且差异有显著性（P<0.05）。 结论 自毒患者的精神科会诊率、院外精神科随诊率较低，入院接诊医生对自毒患者的心理因素关注度可提高精神科会诊率，精神科会诊又与院外精神科随诊密切相关。

[关键词] 综合性医院;自杀;联络会诊;再自杀干预

[中图分类号] R749          [文献标识码] B          [文章编号] 1673-9701（2020）15-0166-04

Investigation and analysis on psychiatric consultation in patients with suicide attempt in primary general hospitals

WENG Xiaojuan1   CHEN Lixian2   WU Fubin3   ZHOU Chaoyun1   YE Jianhua4   FANG Chunyang5

1.Department of Psychiatry，the First People's Hospital of Wenling City in Zhejiang Province，Wenling   317500，China;2.Department of Psychiatry，the Second People's Hospital of Yuhuan City  in Zhejiang Province，Yuhuan   317605，China;3.Department of General Practice Medicine，the First People's Hospital of Wenling City in Zhejiang Province，Wenling   317500，China;4.Medical Record Room，the First People's Hospital of Wenling City in Zhejiang Province，Wenling   317500，China;5.Department of Quality Control，the First People's Hospital of Wenling City in Zhejiang Province，Wenling   317500，China

[Abstract] Objective To understand the psychiatric consultation status of patients attempting suicide in general hospitals. Methods Patients who attempted suicide with drug overdosing or pesticide taking were admitted to two general hospitals in Wenling and Yuhuan City from January 1，2017 to August 31，2019. They were selected as the research subjects. The psychiatric consultation status and influencing factors of patients attempting suicide with poisons were attempted to understand. Results A total of 280 patients with self-poisoning were included in the survey，including 132 females and 148 males. The self-poisoning population was concentrated in the middle-aged and elderly population，with an average age of（49.3±20.5）years old. Only 40% of patients were reported to have histories of mental illness. 144 patients were asked about the cause of self-poisoning by their attending doctors upon admission. During hospitalization，45 patients were given psychiatric consultation，accounting for 16.1% of the total; 62 patients were informed of attending follow-up visits at the outpatient psychiatric clinic upon discharge; there were 45 patients who attended follow-up visits in the department of psychiatry within one month after discharge，accounting for 16.1% of the total survey population. In comparison，psychiatric consultation was more likely to be carried out for the patients with a history of related medical conditions or those who were asked about the cause for self-poisoning upon admission，and the differences were significant（P<0.05）; patients with past medical history，those receiving psychiatric consultation during hospitalization，or those informed of attending follow-up visits at the psychiatric clinic upon discharge were more likely to attend visits at the department of psychiatry after discharge，and the differences were significant. Conclusion The rate of psychiatric consultation and out-of-hospital psychiatric follow-up rate in the patients with self-poisoning are relatively low. Admitting doctors' attention to the psychological factors of patients with self-poisoning can increase the rate of psychiatric consultation，which is then closely related to out-of-hospital psychiatric follow-up visits.

自杀未遂者在出院后2～3年再自杀率高[14，16]，因此首次自杀未遂入院后，是启动再自杀干预和预防的重要环节[17-19]。综合以上研究结果，现病史的描述和既往史均会提示有高精神科会诊率，而高会诊率又会带来高的精神科随诊率，因此需要提高医务人员特别是急诊科、内科、全科医学医生对于自毒患者精神心理因素的关注度和识别能力，如本研究所示，自杀干预和预防可以从现病史问诊时即可启动。当然精神科提高自己的会诊服务也是非常大的挑战，目前很多综合性医院精神科均存在人员不足、会诊量过大的问题[15，20]。如果综合医院建立自杀未遂如自服药物中毒的标准诊治流程、单病种质量监控系统、网络登记及随访制度，可能会更有效的降低自杀未遂和自杀死亡率[6，17，19，20]。

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（收稿日期：2019-12-16）