心脏外科手术患者转出ICU前后睡眠轨迹潜在类别及影响因素研究

doi:10.3761/j.issn.2096-7446.2025.01.007

摘要/Abstract

摘要：

目的探讨心脏外科手术患者转出ICU前后睡眠变化轨迹的潜在类别及影响因素。方法 2023年3月—9月便利选取湖南省某三级甲等医院的210例心血管外科患者为研究对象，采用一般资料调查表、理查兹-坎贝尔睡眠量表、社会支持评定量表、住院前睡眠质量评分、中文版ICU环境压力源量表、简易心理状况评分、疼痛数字评分，在手术前1 d及转出ICU当天、1周、1个月进行调查，使用增长混合模型识别患者睡眠轨迹潜在类别，采用多元Logistic回归分析其影响因素。结果患者的睡眠轨迹可分为严重受损-缓解组（28.1%）、严重受损-持续组（21.4%）、轻度受损-缓解组（50.5%），Logistic回归分析结果显示，家庭人均月收入、住院时长、客观社会支持、疼痛、噪声、ICU环境压力源、心理状况可影响患者睡眠轨迹类别（P<0.05）。结论心脏外科手术患者转出ICU前后睡眠变化轨迹存在异质性，护理人员应重视住院时间长、疼痛持续严重、环境压力感受高、存在心理困扰及社会支持较低的患者各阶段的睡眠变化，并给予针对性干预。

关键词: 心脏外科手术, 重症监护病房, 睡眠质量, 轨迹, 增长混合模型, 护理

Abstract:

Objective To explore the latent classes and influencing factors of sleep trajectories in cardiac surgery patients before and after they are transferred out of the ICU. Methods A total of 210 patients undergoing cardiovascular surgery from March to September of 2023 were selected by convenience sampling. The General Information Questionnaire，Richards-Campbell Sleep Questionnaire，Social Support Rating Scale，Pre-hospitalization Sleep Quality Score，Chinese version of Environment Stressors Questionnaire，the 10-item Kessler Psychological Distress Scale，and Numeric Rating Score were used before surgery and on the day of ICU transfer，1 week and 1 month after ICU transfer. The growth mixed model was used to identify the latent classes of patients’ sleep trajectories，and the influencing factors were analyzed by multivariate logistic regression. Results The sleep trajectory could be divided into severely impaired-remission group（28.1%），severely impaired-persistent group（21.4%），and mildly impaired-remission group（50.5%）. Logistic regression analysis showed that per capita monthly income，length of hospital stay，objective social support，pain，noise，ICU environmental stressors，and psychological status could affect patients’ sleep trajectory（P<0.05）. Conclusion There is heterogeneity in the sleep trajectories of cardiac surgery patients before and after they are transferred out of the ICU，and nursing staff should pay attention to the sleep changes of patients with long hospital stay，persistent and severe pain，high environmental stress，psychological distress and low social support，and give targeted interventions.

Key words: Cardiac Surgical Procedures, Intensive Care Units, Sleep Quality, Trajectory, Growth Mixed Model, Nursing Care

崔大磊, 徐思梦, 张霞, 山李, 王洁, 李乐之. 心脏外科手术患者转出ICU前后睡眠轨迹潜在类别及影响因素研究[J]. 中华急危重症护理杂志, 2025, 6(1): 50-56.

CUI Dalei, XU Simeng, ZHANG Xia, SHAN Li, WANG Jie, LI Lezhi. Research on the latent classes and influencing factors of sleep trajectories in cardiac surgery patients before and after transfer out of ICU[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(1): 50-56.

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