老年出血性脑卒中患者重症监护室-康复过渡期心理弹性与生活质量的相关性

Correlation between psychological resilience and quality of life in elderly patients with hemorrhagic stroke during intensive care unit-rehabilitation transition period

【摘要】目的 探讨老年出血性脑卒中患者重症监护室(ICU)-康复过渡期心理弹性与生活质量情况及其相关性。方法 选择首都医科大学附属北京天坛医院2023年1月至8月收治的160例从ICU转入普通病房的老年出血性脑卒中过渡期患者为研究对象。采用健康状况调查简表(SF-36)调查患者的生活质量,中文版心理弹性量表(CD-RISC)调查心理弹性。采用SPSS 19.0统计软件进行数据分析。根据数据类型,分别采用方差分析、t检验或χ²检验进行组间比较。采用多元线性回归模型分析影响患者生活质量的相关因素。采用Pearson相关性分析评估生活质量与心理弹性的相关性。结果 160份调查问卷中,回收有效问卷147份,问卷回收有效率为91.88%。老年脑卒中ICU-康复过渡期患者生活质量SF-36量表总得分(464.47±56.07)分,心理弹性CD-RISC量表得分(45.38±13.74)分,均低于国内常模,差异均有统计学意义(t=11.619、4.551；P<0.05)。Pearson相关性分析提示,老年脑卒中ICU-康复过渡期患者SF-36量表得分与其CD-RISC量表得分呈正相关(r=0.527；P<0.001)。多元线性回归分析提示,入院时急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)(β=-0.173；P=0.035)、ICU治疗时间(β=-0.355；P<0.001)、机械通气(β=-0.276；P<0.001)、ICU获得性衰弱(ICU-AW)(β=-0.484；P<0.001)、疼痛程度(β=-0.232；P<0.001)、睡眠障碍(β=-0.267；P<0.001)及焦虑(β=-0.191；P=0.016)是影响生活质量的相关因素,其共同解释患者生活质量42.50%的变异度(F=36.251；P<0.001)。结论 老年出血性脑卒中ICU-康复过渡期患者生活质量受入院时病情、ICU治疗因素、睡眠障碍、焦虑及疼痛影响。同时,患者心理弹性下降,积极进行心理弹性相关干预对改善患者生活质量有一定意义。

基金项目:首都医科大学附属北京天坛医院青年科研基金(2021-YQN-06)

【Abstract】Objective To explore the psychological resilience and quality of life (QOL) and their correlation in elderly patients with hemorrhagic stroke during intensive care unit (ICU)-rehabilitation transition period. Methods A total of 160 elderly patients with hemorrhagic stroke during the transition period from ICU to general ward in our hospital from January 2023 to August 2023 were enrolled as the research subjects. Their QOL was investigated by short-form 36-item health survey (SF-36), and the psychological resilience was evaluated by Chinese version of Connor-Davidson resilience scale (CD-RISC). SPSS statistics 19.0 was used for data analysis. Depending on the data type, analysis of variance, student′s t test or Chi-square test was performed for intergroup comparison. Multivariate linear regression model was adopted to analyze the related factors affecting the QOL of patients. Pearson correlation analysis was employed to assess the correlation between QOL and psychological resilience. Results Among the 160 questionnaires, 147 were valid, with an effective rate of 91.88%. The total score of SF-36 scale and score of CD-RISC scale were (464.47±56.07) and (45.38±13.74) points, respectively, in these elderly patients with hemorrhagic stroke during ICU-rehabilitation transition period points, and both were lower than the national norms (t=11.619,4.551; P<0.05). Pearson correlation analysis suggested that SF-36 score was positively correlated with CD-RISC score in the elderly patients (r=0.527; P<0.001). Multivariate linear regression analysis indicated that acute physiology and chronic health evaluationⅡ (APACHEⅡ) score at admission (β=-0.173; P=0.035), length of ICU stay (β=-0.355; P<0.001), mechanical ventilation (β=-0.276; P<0.001), ICU acquired weakness (ICU-AW) (β=-0.484; P<0.001), pain degree (β=-0.232; P<0.001), sleep disorder (β=-0.267; P<0.001) and anxiety (β=-0.191; P=0.016) were related factors affecting QOL, which jointly explained 42.50% of the variance in the QOL of patients (F=36.251; P<0.001). ConclusionThe QOL in elderly patients with hemorrhagic stroke during ICU-rehabilitation transition period is affected by disease condition at admission, ICU treatment factors, sleep disorder, anxiety and pain. Meanwhile, their psychological resilience is decreased. Active psychological resilience-related intervention has certain significance in improving their QOL.

This work was supported by the Youth Research Fund of Beijing Tiantan Hospital, Capital Medical University (2021-YQN-06).