周然 黄雅莲 李娜 黄春蕾 周欣欣 彭维 李敏 方艳春

[摘要] 目的 探討重症监护患者发生急性应激障碍的影响因素，为重症监护患者进行心理护理及心理支持提供依据。 方法 选取2018年11月至2019年5月河北省唐山市某三级甲等医院重症监护患者412例。应用斯坦福急性应激反应问卷评分并确诊急性应激障碍后，给予一般资料问卷、心理弹性量表、社会支持评定量表及艾森克人格问卷简式量表中国版-E量表进行评测，分析影响其急性应激障碍发生的相关因素。 结果 重症监护患者斯坦福急性应激反应问卷总得分为（87.192±10.372）分，心理弹性量表得分为（41.318±9.717）分。单因素分析显示，性别、婚姻状况、文化程度、经济收入状况、年龄及心理弹性水平是重症监护患者发生急性应激障碍的影响因素（P<0.05）。多元线性回归分析显示，年龄、经济收入状况及心理弹性水平是其影响因素（P<0.05）。 结论 重症监护患者急性应激障碍水平较高，建议给予更多心理护理及心理支持，尤其对低年龄、高收入、心理弹性水平低的重症监护患者应给予更多关注，避免发展成为创伤后应激障碍。

[关键词] 急性应激障碍;重症监护患者;影响因素;斯坦福急性应激反应问卷

[中图分类号] R395.6          [文献标识码] B          [文章编号] 1673-9701（2021）03-0163-05

Analysis of impacting factors of acute stress disorder in ICU patients

ZHOU Ran1 HUANG Yalian1， 2 LI Na1  HUANG Chunlei3   ZHOU Xinxin1   PENG Wei1   LI Min1   FANG Yanchun1

1.School of Nursing， University of South China， Hengyang   421001， China; 2.The Central Hospital of Shaoyang in Hu′nan Province， Shaoyang   422000， China; 3.Department of Gastroenterology， the Central Hospital of Shaoyang in Hu′nan Province， Shaoyang   422000， China

[Abstract] Objective To investigate the impacting factors of acute stress disorder in ICU patients， and to provide a basis for psychological nursing and psychological support for ICU patients. Methods A total of 412 ICU patients admitted to a grade 3A hospital in Tangshan City in Hebei Province from November 2018 to May 2019 were selected. After the patients were evaluated by Stanford acute stress reaction questionnaire and diagnosed as acute stress disorder， they were evaluated by general data questionnaire， psychological resilience scale， social support rating scale and Eysenck personality questionnaire short form scale Chinese version-E scale， and the related factors impacting the occurrence of acute stress disorder were analyzed. Results The total score of Stanford acute stress reaction questionnaire and resilience scale in ICU patients were （87.192±10.372） points and （41.318±9.717） points， respectively. Univariate analysis showed that gender， marital status， educational level， personal economic income， age and resilience level were the impacting factors of acute stress disorder in ICU patients（P<0.05）. Multivariate linear regression analysis showed that age， economic income and resilience level were the impacting factors（P<0.05）. Conclusion It is suggested that more psychological nursing and psychological support should be given to ICU patients with higher level of acute stress disorder. In particular， more attention should be paid to the ICU patients with low age， high income and low level of resilience， so as to avoid the development of post-traumatic stress disorder.

[Key words] Acute stress disorder; ICU patients; Impacting factors; Stanford acute stress reaction questionnaire

重症监护病房（Intensive care unit，ICU）是急危重症患者抢救治疗和许多大型手术患者术后监护、护理的重要科室。随着现代医疗技术的不断发展，重症监护患者治愈率逐渐提升，在生理问题大部分得到解决后，患者的心理问题逐渐得到重视。重症监护患者处在各种仪器报警声的包围之中，患者病情及管路迫使其活动受限，机械通气致患者沟通障碍，吸痰等操作给患者带来异常的刺激，因此ICU的治疗经历也可以作为一种创伤体验，使重症监护患者发生急性应激障碍（Acute stress disorder，ASD）。有研究显示，重症监护患者ASD发病率高于一般住院患者[1]，并且对创伤后应激障碍有预测作用[2]。……