| 血管活性药物的应用与创伤后应激障碍的关系 |
| 投稿时间：2025-05-15 修订日期：2025-06-27 点此下载全文 |
| 引用本文：李彦泽,蒋文佳,施琳燕,康洁,叶英,燕宪亮,花嵘.血管活性药物的应用与创伤后应激障碍的关系[J].医学研究杂志,2025,54(12):60-66, 192 |
| DOI：
10.11969/j.issn.1673-548X.2025.12.011 |
| 摘要点击次数: 19 |
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| 基金项目:江苏省基础研究计划(自然科学基金)面上项目(BK20231162)；“淮海经济区5G+区域一体化应急救治体系建设”工信化部和国家卫健委5G+医疗健康应用试点项目(2021年)；徐州市医学领军人才培养项目(XWRCHT20210026) |
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| 中文摘要:目的 探讨急性创伤后应用血管活性药物对创伤后应激障碍(post-traumatic stress disorder, PTSD)发病的影响。方法 采用前瞻性、观察性队列研究,纳入2022年6月～2023年12月就诊于徐州医科大学附属医院重症监护病房的186例急性创伤患者。根据血管活性药物应用情况分为3组,即升压药组(n=66)、降压药组(n=59)和未应用血管活性药物(non-vasoactive drug,NVAD)组(n=61)。收集患者的一般资料、疾病严重程度评分、血管活性药物应用情况(种类、时长)及创伤后1个月的PTSD检查量表(PTSD checklist for DSM-5,PCL-5)评分(≥38分诊断PTSD)。通过多因素Logistic回归分析PTSD发生的危险因素,并采用倾向评分匹配(propensity score matching,PSM)控制混杂变量。结果 共纳入186例急性创伤患者,发生PTSD者68例,总体患病率为36.6%。升压药组PTSD患病率显著高于NVAD组(53.0% vs 24.6%,P<0.05),降压药组与NVAD组差异无统计学意义(30.5% vs 24.6%,P>0.05)。升压药使用时间与PCL-5评分呈正相关(r=0.346,P<0.05)。PTSD组升压药使用时间明显长于非PTSD组(35.0h vs 10.0h,P<0.05)。多因素Logistic回归分析结果显示,升压药使用(OR=3.679,95%CI:1.125~12.034)、损伤严重程度评分(injury severity score,ISS)(OR=1.150,95%CI:1.073~1.232)是PTSD发生的独立危险因素。经PSM分析发现,升压药组PTSD发生风险仍显著高于NVAD组(52.6% vs 5.3%,P<0.05),提示升压药是发生PTSD的独立危险因素。结论 急性创伤后升压药的持续应用是PTSD发生的危险因素。应积极处理导致循环不稳定的危险因素,以减少升压药的应用时间,可能有利于防止PTSD的发生。 |
| 中文关键词:急性创伤 血管活性药物 创伤后应激障碍 危险因素 PCL-5量表 |
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| Relationship between the Application of Vasoactive Drugs and the Post-traumatic Stress Disorder. |
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| Abstract:Objective To explore the effect of vasoactive drugs on the incidence of post-traumatic stress disorder (PTSD). Methods A prospective observational cohort study was conducted, including 186 acute trauma patients admitted to the ICU of the Affiliated Hospital of Xuzhou Medical University from June 2022 to December 2023. The patients were divided into 3groups according to the use of vasoactive drugs:the pressor group (n=66), the antihypertensive group (n=59), and the non-vasoactive drug (NVAD) group (n=61). General data, disease severity scores, vasoactive drug usage (type, duration), and the PTSD Checklist for DSM-5 (PCL-5) scores (PTSD diagnosed at ≥38 points) one month after trauma of the patients were collected. Multivariate Logistic regression was used to analyze the risk factors for PTSD occurrence, and propensity score matching (PSM) was used to control confounding variables. ResultsA total of 186severe trauma patients were included, with 68 developed PTSD, resulting in an overall prevalence of 36.6%. The prevalence of PTSD in the pressor group was significantly higher than that in the NVAD group (53.0% vs 24.6%, P<0.05), while there was no significant difference between the antihypertensive group and the NVAD group (30.5% vs 24.6%, P>0.05). The duration of pressor use was positively correlated with PCL-5scores (r=0.346, P<0.05). Patients in the PTSD group had a significantly longer duration of pressor use than those in the non-PTSD group (35.0h vs 10.0h, P<0.05). Multivariate Logistic regression analysis revealed that pressor use (OR= 3.679,95%CI:1.125-12.034) and injury severity score (ISS) (OR=1.150,95%CI:1.073-1.232) were the independent risk factors for PTSD. PSM analysis revealed that the risk of PTSD in the pressor group remained significantly higher than that in the NVAD group (52.6% vs 5.3%, P<0.05), indicating that pressor drugs is an independent risk factor for the occurrence of PTSD. Conclusion The continuous application of pressor drugs after acute trauma is a risk factor for the occurrence of PTSD. Risk factors leading to circulatory instability should be actively managed to reduce the duration of pressor drugs application, which may be beneficial in preventing the occurrence of PTSD. |
| keywords:Acute trauma Vasoactive drugs Post-traumatic stress disorder Risk factors PCL-5scale |
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