ISSN 2097-6046（网络）
ISSN 2096-7446（印刷）
CN 10-1655/R
主管：中国科学技术协会
主办：中华护理学会
中华急危重症护理杂志

中华急危重症护理杂志 >

2024 , Vol. 5 >Issue 3: 197 - 204

DOI: https://doi.org/10.3761/j.issn.2096-7446.2024.03.001

论著

脓毒症后综合征患者症状特征的潜在类别分析

  • 陈玉珍 ,
  • 郑剑煌 ,
  • 姜志钊 ,
  • 郑雪兰 ,
  • 郑翠红
展开
  • 362300 泉州市 福建医科大学附属第二医院重症医学科（陈玉珍,郑剑煌,姜志钊,郑雪兰）; 福建卫生职业技术学院（郑翠红）
陈玉珍：女,硕士,护师,E-mail：chenyz1989@126.com

收稿日期: 2023-06-29

  网络出版日期: 2024-03-22

基金资助

福建省青年教师教育科研项目（JAT200134）; 福建医科大学附属第二医院重点学科专项（HLZDZK202308）

收起

Latent class analysis of symptom characteristics in patients with post-sepsis syndrome

  • CHEN Yuzhen ,
  • ZHENG Jianhuang ,
  • JIANG Zhizhao ,
  • ZHENG Xuelan ,
  • ZHENG Cuihong
Expand
  • Department of Critical Care Medicine,the Second Affiliated Hospital of Fujian Medical University,Fujian, 362300,China

Received date: 2023-06-29

  Online published: 2024-03-22

Fold

摘要

目的 探讨脓毒症后综合征患者症状的潜在类别,并分析不同潜在类别的影响因素。方法 采用便利抽样方法,选取2021年1月—7月在福建省某三级甲等综合医院出院的脓毒症患者,患者出院后第3个月通过门诊及电话、微信视频相结合的方式进行问卷调查。对脓毒症后综合征患者的症状特征进行潜在类别分析,并通过单因素分析和多项分类Logistic回归识别其潜在类别的影响因素。结果 共纳入347例脓毒症出院患者,其中216例（62.25%）发生脓毒症后综合征,出院后3个月认知障碍发生率为67.12%,焦虑发生率为61.57%,抑郁发生率为51.78%,睡眠障碍发生率为78.70%,日常生活能力障碍发生率为56.48%;脓毒症后综合征患者症状特征分别为“高症状组”（占比25.93%）、“认知—日常生活能力障碍组”（占比32.87%）和“睡眠障碍组”（占比41.20%）;有既往史、使用镇痛药物越多归于“高症状组”的概率越大,APACHEⅡ评分越高归于“高症状组”与“认知—日常生活能力障碍组”的概率越大,社会支持水平越高的归于“高症状组”与“认知—日常生活能力障碍组”的概率越小,激素药物使用越多归于“睡眠障碍组”的概率越小。结论 脓毒症后综合征患者症状特征可分为“高症状组”“认知—日常生活能力障碍组”“睡眠障碍组”3个潜在类别,既往史、镇痛药物及激素使用、APACHEⅡ评分、社会支持等因素在各潜在类别中存在异质性,可以预测各症状潜在类别的归属。

关键词： 脓毒症后综合征; 潜在类别分析; 症状体验模型; 危重病护理

本文引用格式

陈玉珍 , 郑剑煌 , 姜志钊 , 郑雪兰 , 郑翠红 . 脓毒症后综合征患者症状特征的潜在类别分析[J]. 中华急危重症护理杂志, 2024 , 5(3) : 197 -204 . DOI: 10.3761/j.issn.2096-7446.2024.03.001

Abstract

Objective To explore the latent classes of symptoms in patients with post-sepsis syndrome, and to analyze the factors affecting the different classes. Methods Convenience sampling method was used to select sepsis patients discharged from a tertiary Grade A general hospital in Fujian Province from January 2021 to July 2021. Questionnaire survey was conducted three months after discharge through outpatient department, telephone and wechat. The latent classes of symptoms were analyzed,and the influencing factors were identified by univariate analysis and multinomial Logistic regression. Results Among 347 discharged patients with sepsis, 216 cases (62.25%) developed post-sepsis syndrome, and the incidence of cognitive impairment 67.12%,anxiety 61.57%, depression 51.78%,and sleep disorder 78.70% three months after discharge. The incidence of disability of daily living was 56.48%. The symptoms of post-sepsis syndrome patients were “high symptom group”（25.93%）,“cognitive daily living impairment group”（32.87%） and “sleep disorder group”（41.20%）. The odds of patients having a previous history and using more analgesics were greater in the “high symptom group”, the odds of having a higher APACHEⅡ score in the “high symptom group” and “cognitive-daily living impairment group” were greater, and the odds of having a higher level of social support in the “high symptom group” and “cognitive-daily living impairment group” were lower. The higher the use of hormone medication, the lower the risk of being classified as “sleep disorder group”. Conclusion The symptoms of patients with post-sepsis syndrome can be divided into three latent classes：“high symptom group” “cognitive-daily living impairment group” and “sleep disorder group”. There is heterogeneity in the latent classes of symptoms of patients with post-sepsis syndrome concerning previous history, analgesic drug use, hormone drug use, APACHEⅡscore and social support. The latent classes of symptoms can be predicted.

Key words： Post-sepsis Syndrome; Latent Class Analysis; Symptom Experience Model; Critical Care Nursing

参考文献

[1] Mostel Z,Perl A,Marck M,et al.Post-sepsis syndrome-an evolving entity that afflicts survivors of sepsis[J]. Mol Med,2019,26(1):6.
[2] Hajj J,Blaine N,Salavaci J,et al.The “centrality of sepsis”:a review on incidence,mortality,and cost of care[J]. Healthcare (Basel),2018,6(3):90.
[3] Prescott HC,Angus DC.Enhancing recovery from sepsis:a review[J]. JAMA,2018,319(1):62-75.
[4] 陈擎仪. 妊娠相关焦虑的潜在类别及其与生活质量的关系[D]. 济南:山东大学,2021.
Chen QY.Potential categories of pregnancy-related anxiety and its relationship with quality of life[D]. Jinan:Shandong University,2021.
[5] 李峥,刘宇. 护理学研究方法[M]. 2版. 北京:人民卫生出版社,2018.
Li Z,Liu Y.Nursing research methods[M]. 2nd ed. Beijing:People's Medical Publishing House,2018.
[6] van der Slikke EC,Beumeler L,Holmqvist M,et al. Understanding post-sepsis syndrome:how can clinicians help?[J]. Infect Drug Resist,2023,16:6493-6511.
[7] 周小炫. 中文版简易智能精神状态检查量表在脑卒中患者中的信效度初步研究[D]. 福州:福建中医药大学,2015.
Zhou XX.A preliminary study on the reliability and validity of the Chinese version of the simple intelligent mental state examination scale in stroke patients[D]. Fuzhou:Fujian University of Traditional Chinese Medicine,2015.
[8] Snaith RP.The hospital anxiety and depression scale[J]. Health Qual Life Outcomes,2003,1:29.
[9] Fi M,Dw B.Functional evaluation:the barthel index[J]. Ma State Med J,1965,14:61-65.
[10] 孙英明,孙娜,张敏,等. ICU转出患者睡眠障碍及其评估工具的研究进展[J]. 中国护理管理,2020,20(6):950-955.
Sun YM,Sun N,Zhang M,et al.Research progress on sleep disorder in post-ICU patients and relevant assessment tools[J]. Chin Nurs Manag,2020,20(6):950-955.
[11] 肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志,1994,4(2):98-100.
Xiao SY.Theoretical basis and research application of Social Support rating Scale[J]. J Clin Psychol Med,1994,4(2):98-100.
[12] 王孟成,毕向阳. 潜变量建模与Mplus应用:进阶篇[M]. 重庆:重庆大学出版社,2018:13-15.
Wang MC,Bi XY.Latent variable modeling and Mplus appli-cation advanced chapter[M]. Chongqing:Chongqing University Press,2018:13-15.
[13] 石丹,李铮,杨坚,等. 脑卒中病人症状特征的潜在类别分析[J]. 护理研究,2018,32(20):3184-3189.
Shi D,Li Z,Yang J,et al.Potential category analysis of symptom characteristics in stroke patients[J]. Chin Nurs Res,2018,32(20):3184-3189.
[14] 何曼曼,江智霞,张芳,等. ICU后综合征患者症状特征的潜在类别分析[J]. 中华护理杂志,2021,56(10):1445-1452.
He MM,Jiang ZX,Zhang F,et al.Latent class analysis of symptom characteristics in patients with post-intensive care syndrome[J]. Chin J Nurs,2021,56(10):1445-1452.
[15] Leviner S.Post-sepsis syndrome[J]. Crit Care Nurs Q,2021,44(2):182-186.
[16] Bozza FA,D'Avila JC,Ritter C,et al. Bioenergetics,mitochondrial dysfunction,and oxidative stress in the pathophysiology of septic encephalopathy[J]. Shock,2013,39(Suppl 1):10-16.
[17] 韩婷婷. 经皮肾镜取石术后并发脓毒血症的危险因素分析[D]. 昆明:昆明医科大学,2018.
Han TT.Risk factors of sepsis after percutaneous nephrolithotomy[D]. Kunming:Kunming Medical University,2018.
[18] 戚锡铅,周男华. 以失眠为主症的阈下焦虑抑郁患者中医证型分布[J]. 浙江中西医结合杂志,2021,31(12):1147-1149.
Qi XQ,Zhou NH.Distribution of TCM syndrome types in subthreshold anxiety and depression patients with insomnia as the main symptom[J]. Zhejiang J Integr Tradit Chin West Med,2021,31(12):1147-1149.
[19] 姚丽,丁楠楠,杨丽平,等. 重症患者转出ICU后认知损害危险因素的Meta分析[J]. 中国护理管理,2018,18(12):1634-1643.
Yao L,Ding NN,Yang LP,et al.Risk factors for cognitive impairment after critical illness:a Meta-analysis[J]. Chin Nurs Manag,2018,18(12):1634-1643.
[20] 王霞,邓娟,熊杰,等. 基于故障树理论和eCASH理念的ICU患者镇静镇痛管理策略[J]. 护理学杂志,2020,35(4):39-43.
Wang X,Deng J,Xiong J,et al.Construction and application of ICU sedative and analgesic management strategy based on Fault Tree Theory and eCASH(early Comfort using Analgesia,minimal Sedatives and maximal Humane care) concept[J]. J Nurs Sci,2020,35(4):39-43.
[21] Widmann CN,Sinning JM,Ghanem A,et al.p2-088:chronic and acute systemic inflammation and long-term cognitive decline[J]. Alzheimer's Dement,2017,13(7S_Part_13):640.
[22] Lee M,Kang J,Jeong YJ.Risk factors for post-intensive care syndrome:a systematic review and meta-analysis[J]. Aust Crit Care,2020,33(3):287-294.
[23] 万娜,常鑫儿,张春艳,等. ICU后门诊的建立与运行实践[J]. 中国护理管理,2021,21(4):566-569.
Wan N,Chang XE,Zhang CY,et al.Practice of establishment and operation of post-ICU clinic[J]. Chin Nurs Manag,2021,21(4):566-569.
[24] 吕俭霞,殷利,程平,等. 头颈肿瘤病人支持性照护需求与社会支持、焦虑及抑郁的相关性研究[J]. 循证护理,2021,7(8):1021-1025.
Lü JX,Yin L,Cheng P,et al.Study on the correlation among the supportive care needs and social support,anxiety and depression of patients with head and neck tumors[J]. Chin Evid Based Nurs,2021,7(8):1021-1025.
[25] 王进菊,李应国,孙法强,等. 颈髓损伤并四肢瘫痪患者的社会支持、心理状态和生活质量之间的关系[J]. 国际精神病学杂志,2021,48(6):1149-1152.
Wang JJ,Li YG,Sun FQ,et al.The relationship among social support,psychological state and quality of life in spinal cord injury patients with paralysis of limbs[J]. J Int Psychiatry,2021,48(6):1149-1152.
[26] 张磊,赵玉武,唐春雷,等. 白细胞介素-1β及前列腺素E在帕金森病伴发快速眼动睡眠障碍的老年患者中水平及临床意义[J]. 中国老年学杂志,2022,42(2):343-346.
Zhang L,Zhao YW,Tang CL,et al.Levels and clinical signif-icance of interleukin-1β and prostaglandin E in elderly pa-tients with Parkinson's disease complicated with rapid eye movement sleep disorder[J]. Chin J Gerontol,2022,42(2):343-346.
[27] 彭仁梅,钱荣,李亚军,等. ICU转出患者睡眠障碍风险列线图预测模型的构建与验证[J]. 护理学报,2023,30(15):16-22.
Peng RM,Qian R,Li YJ,et al.Construction and validation of nomogram to predict sleep disorder risk in patients transferred from ICU[J]. J Nurs,2023,30(15):16-22.
Options
文章导航

/

〈 〉