感染性休克机械通气患者撤机后并发创伤后应激障碍的影响因素分析OA
Analysis of Factors Influencing Post-Traumatic Stress Disorder After Weaning from Mechanical Ventilation in Patients with Septic Shock
目的 分析感染性休克机械通气患者撤机后并发创伤后应激障碍(PTSD)的影响因素,并构建列线图模型.方法 选取2022年1月至2025年8月南京医科大学第一附属医院收治的196例行机械通气的感染性休克患者.根据撤机后是否并发PTSD,将患者分为PTSD阳性组(47例)和PTSD阴性组(149例).采用多因素Logistic逐步回归分析感染性休克机械通气患者撤机后并发PTSD的影响因素.绘制列线图并采用受试者工作特征曲线评估列线图模型对感染性休克机械通气患者撤机后并发PTSD的预测价值.结果 PTSD阳性组女性、消极应对方式、人格特征为内向、社会支持低水平、机械通气时间>7 d、谵妄持续时间>48 h、侵入性操作种类>3种所占比例,以及急性生理学与慢性健康状况评估Ⅱ、重症监护疼痛观察工具(CPOT)、焦虑自评量表评分均显著高于PTSD阴性组(P<0.05).多因素分析显示,女性(OR=3.579,95%CI:1.631～7.854)、机械通气时间>7 d(OR=3.425,95%CI:1.752～6.695)、谵妄持续时间>48 h(OR=3.347,95%CI:1.646～6.804)、CPOT评分较高(OR=2.606,95%CI:1.409～4.823)、消极应对方式(OR=2.787,95%CI:1.443～5.385)是感染性休克机械通气患者撤机后并发PTSD的独立危险因素(P<0.05).列线图模型显示,一致性指数为0.875(95%CI:0.825～0.924).列线图模型预测感染性休克机械通气患者撤机后并发PTSD的曲线下面积为0.858(95%CI:0.808～0.905),特异度为65.10%,灵敏度为91.49%.结论 性别、机械通气时间、谵妄持续时间、CPOT评分、应对方式是感染性休克机械通气患者撤机后并发PTSD的独立危险因素,据此构建的列线图模型具有良好的预测效能.
Objective To analyze the influencing factors of post-traumatic stress disorder(PTSD)in patients with septic shock after weaning from mechanical ventilation and to construct a nomogram model.Methods A total of 196 patients with septic shock who underwent mechanical ventilation admitted to the First Affiliated Hospital of Nanjing Medical University from January 2022 to August 2025 were selected.According to whether PTSD occurred after weaning from mechanical ventilation,the patients were divided into the PTSD-positive group(n=47)and the PTSD-negative group(n=149).The influencing factors of PTSD in patients with septic shock after weaning from mechanical ventilation were investigated by multivariate stepwise logistic regression analysis.A nomogram was drawn and the predictive value of the nomogram model for PTSD in patients with septic shock after weaning from mechanical ventilation was evaluated by the receiver operating characteristic curve.Results The proportions of females,negative coping style,introverted personality trait,low level of social support,mechanical ventilation duration>7 days,delirium duration>48 hours,and types of invasive procedures>3 in the PTSD-positive group were higher than those in the PTSD-negative group,and the acute physiology and chronic health evaluationⅡscore,critical-care pain observation tool(CPOT)score,and self-rating anxiety scale score were all higher in the PTSD-positive group than in the PTSD-negative group(P<0.05).Multivariate analysis showed that female(OR=3.579,95%CI:1.631-7.854),mechanical ventilation duration>7 days(OR=3.425,95%CI:1.752-6.695),delirium duration>48 hours(OR=3.347,95%CI:1.646-6.804),higher CPOT score(OR=2.606,95%CI:1.409-4.823),and negative coping style(OR=2.787,95%CI:1.443-5.385)were independent risk factors for PTSD in patients with septic shock after weaning from mechanical ventilation(P<0.05).The nomogram model showed that the concordance index was 0.875(95%CI:0.825-0.924).The area under the curve of the nomogram model for predicting PTSD in patients with septic shock after weaning from mechanical ventilation was 0.858(95%CI:0.808-0.905),with a specificity of 65.10%and a sensitivity of 91.49%.Conclusion Gender,mechanical ventilation duration,delirium duration,CPOT score,and coping style are independent risk factors for PTSD in patients with septic shock after weaning from mechanical ventilation.The nomogram model constructed based on these factors has good predictive performance.
董琦;张茹;丁玲玉;宋洪涛;秦天娥
南京医科大学第一附属医院/江苏省人民医院普通外科,南京 210003南京医科大学第一附属医院/江苏省人民医院普通外科,南京 210003南京医科大学第一附属医院/江苏省人民医院结直肠外科,南京 210003南京医科大学第一附属医院/江苏省人民医院普通外科,南京 210003南京医科大学第一附属医院/江苏省人民医院普通外科,南京 210003
感染性休克机械通气创伤后应激障碍影响因素
septic shockmechanical ventilationpost-traumatic stress disorderinfluencing factors
《转化医学杂志》 2026 (4)
541-546,6
国家自然科学基金项目(72404140)
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