纠纷或差错事故后医护人员心理健康研究的Meta分析

目的对纠纷或差错事故后医护人员心理健康研究的结果进行Meta分析，为医护人员心理健康状况的评估提供理论依据。方法检索2000—2011年的中国知网全文数据库（CNKI）、中国生物医学文献服务系统（SinoMed）、万方数据资源系统、中华医学会期刊等电子资源数据库中有关护患纠纷、医患纠纷、差错事故发生后医护人员症状自评量表（SCL 90）状况的实证研究，共收集文献37篇，有效文献5篇，其中文献样本量最少的36人，样本量最大的为276人。以1986年全国常模为对照群体，对有效文献进行Meta分析。结果纠纷或差错事故后医护人员SCL 90得分状况的合并效应显示，纠纷或差错事故后医护人员整体心理健康水平低于1986年全国常模，躯体化、人际关系敏感、焦虑、恐怖和偏执5项的效应尺度d（95%CI）分别为0.70（0.51～0.83），0.75（0.65～0.83），0.78（0.58～0.89），0.60（0.30～0.79），0.53（0.46～0.59），均为中效应（0.20.8），差异有统计学意义（Z值分别为24.02,6.40,4.52;P〈0.01）；而精神病性选项与常模比较差异无统计学意义［d＝0.12（-0.15～0.36）, P〉0.05］。结论纠纷或差错事故发生后医护人员心理健康水平较低，因此在纠纷或差错事故后应该及时、有效、有针对性地对医护人员进行心理干预。

Meta-analysis of psychological health in medical staff after dispute and error accident

Objective To analyze the survey results of Symptom Check List 90 （SCL-90） obtained from medical staff after dispute and error accident in order to provide theoretical evidence for evaluating the psychological health status of medical staff under this specific circumstance. Methods Empirical studies regarding SCL-90 test results of medical staffs after occupational negative event including nurse-patient dispute, medical dispute and error accident between 2000 and 2011 were retrieved. A total of 37 literatures were collected, among them ,5 effective samples were presented. The minimum sample size was 36 and the maximum was 276 individuals. The national norms, established by Jin et al in 1986, were applied as reference group. Results The combined effect of SCL-90 score that obtained from medical staff after dispute and error accident revealed that overall psychological health level was significantly lower than that national norms. The five parameters including somatization, personal relationship sensitivity, anxiety, terror, and paranoia showed medium effect （0.2 〈 d 〈 0. 8 ）, d （95% CI） value were 0.70 （O. 51 - 0.83 ）, 0. 75 （0. 65 - 0. 83 ）, 0. 78 （0.58 - 0.89） ,0.60 （0.30 - 0.79 ）, 0.53 （ 0.46 ~ 0.59 ）, respectiveley, and the difference were statistically significant （Z = 5.53,9.46,5.49,3.55,13.06, respectively; P 〈 0. 01 ）. Obsessive-compulsive symptom, depression and hostility presented high effect （ d 〉 0. 8 ）, d （95 % CI） value were 0.84 （0.81 - 0.87 ） , 0.85 （0.70 - 0.93 ） ,0.82 （0.58 - 0. 93 ）, respectiveley, and the difference were statistically significant （Z = 24.02, 6.40,4.52, respectively; P 〈 0.01 ）. While no significant difference were detected in psychotic items （P 〉 0.05）. Conclusions Statistical results suggest that medical staff present relatively low level of psychological health status after dispute and error accident. Therefore, special psychological interventions should be given to medical staff timely and effectively afterwards.