收稿日期: 2024-01-15
网络出版日期: 2025-01-14
基金资助
湖南省卫生健康委科研课题(B202314027105)
Research on the latent classes and influencing factors of sleep trajectories in cardiac surgery patients before and after transfer out of ICU
Received date: 2024-01-15
Online published: 2025-01-14
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。
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 . DOI: 10.3761/j.issn.2096-7446.2025.01.007
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.
| [1] | 郝星. 2022年中国心血管外科手术和体外循环数据白皮书[J]. 中国体外循环杂志, 2023, 21(4):197-200. |
| Hao X. White book of Chinese cardiovascular surgery and extracorporeal circulation in 2022[J]. Chin J Extracorpor Circ, 2023, 21(4):197-200. | |
| [2] | Kolat P, Guttenberger P, Ried M, et al. ICU readmission after cardiac surgery-still a matter of concern?[J]. Thorac Cardiovasc Surg, 2020, 68(5):384-388. |
| [3] | 宋秀秀, 吴娟, 王逸楠. ICU转出患者睡眠障碍发生率的系统评价[J]. 中华护理杂志, 2023, 58(6):743-750. |
| Song XX, Wu J, Wang YN. Prevalence of sleep disorders in post-ICU patients:a systematic review[J]. Chin J Nurs, 2023, 58(6):743-750. | |
| [4] | Ahmad A, Didia SC. Effects of sleep duration on cardiovascular events[J]. Curr Cardiol Rep, 2020, 22(4):18. |
| [5] | Caruana N, McKinley S, Elliott R, et al. Sleep quality during and after cardiothoracic intensive care and psychological health during recovery[J]. J Cardiovasc Nurs, 2018, 33(4):E40-E49. |
| [6] | 李良俊, 翟荣, 邬闻文, 等. Logistic回归及决策树模型在CCU老年病人睡眠障碍影响因素分析中的应用[J]. 护理研究, 2022, 36(16):2874-2879. |
| Li LJ, Zhai R, Wu WW, et al. Application of Logistic regression and decision tree model in the analysis of influencing factors of sleep disorders in CCU elderly patients[J]. Chin Nurs Res, 2022, 36(16):2874-2879. | |
| [7] | Miranda-Ackerman RC, Lira-Trujillo M, Gollaz-Cervantez AC, et al. Associations between stressors and difficulty sleeping in critically ill patients admitted to the intensive care unit:a cohort study[J]. BMC Health Serv Res, 2020, 20(1):631. |
| [8] | Barcikowski RS, Robey RR. Decisions in single group repeated measures analysis:statistical tests and three computer packages[J]. Am Stat, 1984, 38(2):148. |
| [9] | Richards KC, O’Sullivan PS, Phillips RL. Measurement of sleep in critically ill patients[J]. J Nurs Meas, 2000, 8(2):131-144. |
| [10] | 陈丽霞, 纪代红, 赵巧玉, 等. 中文版理查兹-坎贝尔睡眠量表的信效度研究[J]. 中华护理杂志, 2016, 51(9):1141-1144. |
| Chen LX, Ji DH, Zhao QY, et al. The reliability and validity of the Chinese version of Richards-Campbell Sleep Questionnaire[J]. Chin J Nurs, 2016, 51(9):1141-1144. | |
| [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 Psychiatry, 1994, 4(2):98-100. | |
| [12] | Cornock MA. Stress and the intensive care patient:perceptions of patients and nurses[J]. J Adv Nurs, 1998, 27(3):518-527. |
| [13] | 苏丽静, 颜艺鹭, 黄文娟, 等. 中文版ICU环境压力源量表的修订和信效度评价[J]. 中华护理杂志, 2018, 53(4):508-512. |
| Su LJ, Yan YL, Huang WJ, et al. Reliability and validity of Chinese version of Intensive Care Unit Environment Stressor Questionnaire[J]. Chin J Nurs, 2018, 53(4):508-512. | |
| [14] | Kessler RC, Mroczek DK. Final versions of our Non-Specific Psychological Distress Scale[C]. 1994. |
| [15] | 周成超, 楚洁, 王婷, 等. 简易心理状况评定量表Kessler10中文版的信度和效度评价[J]. 中国临床心理学杂志, 2008, 16(6):627-629. |
| Zhou CC, Chu J, Wang T, et al. Reliability and validity of 10-item Kessler Scale(K10) Chinese version in evaluation of mental health status of Chinese population[J]. Chin J Clin Psychol, 2008, 16(6):627-629. | |
| [16] | 喻嘉宏, 陈小娜, 郜艳晖, 等. 潜变量增长混合模型在医学研究中的应用[J]. 中国卫生统计, 2018, 35(4):496-499. |
| Yu JH, Chen XN, Gao YH, et al. The application of latent growth mixture modeling in the medical research[J]. Chin J Health Stat, 2018, 35(4):496-499. | |
| [17] | Ritmala-Castren M, Axelin A, Richards KC, et al. Investigating the construct and concurrent validity of the Richards-Campbell Sleep Questionnaire with intensive care unit patients and home sleepers[J]. Aust Crit Care, 2022, 35(2):130-135. |
| [18] | Bakry AM, Abdelmohty H, Badawy AE, et al. Sleep disturbance:the overlooked side after open heart surgery in adults[J]. Asian Cardiovasc Thorac Ann, 2022, 30(3):300-306. |
| [19] | Chan JL, Ng DWL, Liao QY, et al. Trajectories of sleep disturbance in cancer survivors during the first 2 years post-treatment[J]. Sleep, 2023, 46(8):zsad052. |
| [20] | Jun J, Kapella MC, Hershberger PE. Non-pharmacological sleep interventions for adult patients in intensive care units:a systematic review[J]. Intensive Crit Care Nurs, 2021,67:103124. |
| [21] | 陈巧玲, 林如玉, 朱宣静, 等. ICU身体约束患者心理弹性水平及影响因素的路径分析[J]. 中华急危重症护理杂志, 2024, 5(1):10-15. |
| Chen QL, Lin RY, Zhu XJ, et al. The levels of psychological resilience and influencing factors path analysis in ICU patients with physical restrain[J]. Chin J Emerg Crit Care Nurs, 2024, 5(1):10-15. | |
| [22] | Papadopoulos D, Etindele Sosso FA. Socioeconomic status and sleep health:a narrative synthesis of 3 decades of empirical research[J]. J Clin Sleep Med, 2023, 19(3):605-620. |
/
| 〈 |
|
〉 |