骨科手术相关创伤后应激障碍的发生及高危因素分析

文题释义：创伤后应激障碍：是指个体经历、目睹或遭遇到一个或多个涉及自身或他人的实际死亡，或受到死亡的威胁，或严重的受伤，或躯体完整性受到威胁后，所导致的个体延迟出现和持续存在的精神障碍。 高危因素：是指能够显著增加疾病或死亡发生的可能性的因素，是指疾病的发生与该因素有一定的因果关系，但是尚无可靠的证据能够证明该因素的致病效应，但是当消除该因素时，疾病的发生概率也随之下降。 背景：近年来，随着骨科手术技术的不断进步，手术数量迅速增加，患者的术后康复问题也愈发受到关注。创伤后应激障碍作为骨科术后常见的精神障碍，其发生与患者的人口统计学特征、社会心理因素、创伤特点、既往精神状况以及围术期心血管指标等因素均有关联。同时既往研究表明，术后创伤后应激障碍与患者康复情况密切相关。 目的：通过查阅近年国内外骨科术后创伤后应激障碍及术后康复的相关文献，对骨科术后创伤后应激障碍的发生情况、高危因素及其与术后康复的关系进行分析，以期指导术后创伤后应激障碍的早期诊断及干预。 方法：第一、二作者分别应用计算机检索1990年1月至2019年10月PubMed数据库、Embase数据库、中国期刊全文数据库(CNKI)及万方数据库相关文章，英文检索词为“orthopedic，surgery/operation，PTSD，risk factor，rehabilitation”，中文检索词为“骨科，手术，创伤后应激障碍，高危因素，康复”。共检索到文献94篇，其中56篇符合纳入标准。 结果与结论：①依据术式的不同，骨科患者在术后有15%-40%的可能出现不同程度的创伤后应激障碍，其中下肢截肢手术后创伤后应激障碍发病率最高；②年轻、女性、低收入、低教育程度、缺乏社会支持、高度遗传易感性、术前不良心理状态、心理弹性差、低血压、高心率、高度疼痛敏感性都是骨科术后短期内发生创伤后应激障碍的高危因素；③术前创伤和手术本身创伤的严重程度与术后创伤后应激障碍的发生并无明确关联，但对术后生活、工作能力影响大的手术易于引发创伤后应激障碍；④术后出现创伤后应激障碍的患者可能产生不良的远期预后。 ORCID: 0000-0002-9187-9318(闫延) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Occurrence and high risk factors of post-traumatic stress disorder related to orthopedic surgery

BACKGROUND:In recent years,with the continuous progress of orthopedic surgery technology and the rapid increase in the number of orthopedic surgery,more and more attention has been paid to the postoperative rehabilitation of patients.As a common mental disorder after orthopedic surgery,the occurrence of post-traumatic stress disorder is related to demographic characteristics,psychosocial factors,trauma characteristics,past mental status and perioperative cardiovascular indicators.At the same time,previous studies have shown that postoperative post-traumatic stress disorder is closely related to the rehabilitation of patients.OBJECTIVE:By consulting the related literature of post-traumatic stress disorder and postoperative rehabilitation after orthopedic surgery in recent years,this paper analyzed the occurrence,high risk factors and the relationship between post-traumatic stress disorder and postoperative rehabilitation after orthopedic surgery,in order to guide the early diagnosis and intervention of postoperative post-traumatic stress disorder.METHODS:The first author and the second author searched the related articles in PubMed database,Embase database,China National Knowledge Infrastructure(CNKI)and Wanfang database from January 1990 to October 2019 with the English key words of“orthopedic,surgery/operation,PTSD,risk factor,rehabilitation”and the Chinese words of“orthopedics,surgery,PTSD,high risk factors,rehabilitation”.A total of 94 articles were retrieved,of which 56 met the inclusion criteria.RESULTS AND CONCLUSION:(1)According to the type of operation,about 15%-40%of orthopedic patients may have varying degrees of post-traumatic stress disorder after surgery,and the incidence of post-traumatic stress disorder after lower limb amputation is highest.(2)Youth,female,low income,low education,lack of social support,high genetic susceptibility,poor psychological state before operation,poor psychological elasticity,hypotension,high heart rate and high pain sensitivity are all high risk factors for post-traumatic stress disorder after orthopedic surgery.(3)There is no clear correlation between the severity of preoperative trauma and the trauma of the operation itself and the occurrence of postoperative post-traumatic stress disorder,but the surgery with great influence on the ability of life and work after operation easily causes post-traumatic stress disorder.(4)Patients with postoperative post-traumatic stress disorder may have poor long-term prognosis.