ICU患者抑郁焦虑发生的危险因素分析

目的探讨ICU患者住院期间抑郁焦虑的发病率及出院后抑郁焦虑的危险因素。方法前瞻性研究,入选在我院ICU进行治疗的250例神志清楚及智力正常的患者,记录患者的性别、年龄、教育程度、原发病的严重程度[以Charlson Co-morbidity index(CCI)量表评估]、APACHEⅡ评分、呼吸机使用天数、每日睡眠时间、入住ICU的时间等10项资料,在入院4 d后以医院焦虑抑郁量表(HADS)来测评其住院期间抑郁焦虑的发病率;在患者出院2个月内,成功随访195例,以HADS量表再次测评患者出院后抑郁焦虑的发生情况,采用多元线性回归分析找出与患者出院后抑郁焦虑发生的有关危险因素。结果 ICU患者住院期间抑郁焦虑的发生率为24%;多元线性回归分析表明:CCI评分(P<0.01),住院期间HADS评分(P<0.05),入住ICU时间(P<0.01)3项为患者出院后抑郁发病的危险因素;CCI评分(P<0.01),APACHEⅡ评分(P<0.05),住院期间出现谵妄(P<0.05),住院期间HADS评分(P<0.05),入住ICU时间(P<0.01)5项因素为患者出院后焦虑发生的危险因素。结论 ICU患者住院期间抑郁焦虑的发病率较高。原发病较重,住院期间出现精神症状,入住ICU时间长是患者出院后出现抑郁症状的危险因素;原发病较重,APACHEⅡ评分较高,且住院期间出现精神、谵妄症状,入住ICU时间长是患者出院后出现焦虑症状的危险因素。

Risk factors of depression and anxiety in patients with critical illness

Objective To investigate the incidence of anxiety and depression in ICU patients, and it＇s risk factors after discharge. Methods 250 patients with normal consciousness and intelligence treated in ICU were enrolled for a prospective study from January 2010 to January 2014. Potential risk factors such as Gender, age, education level, severity of disease, APACHEⅡ score, ventilator days, daily sleep time, ICU stay time etc were collected. Hospital Anxiety and Depression Scale（HADS） was used to evaluate the incidence of anxiety and depression in 4 days after admission. Two months after discharge from ICU, 195 survivors of our group received the HADS to estimate the degree of psychological problem. Using multiple linear regression analysis to identify the related risk factors. Results The incidence of depression and anxiety during hospitalization in ICU was 24%. In multiple regression analysis, major pre-existing disease defined by CCI score（P〈0.01）, HADS score（P〈0.05）, ICU length of stay（P〈0.01） were significant independent risk factors for depression of patients discharged from ICU. CCI score（P〈0.01）, HADS score（P〈0.05）, APACHEII score（P〈0.05）, in-ICU delirium（P〈0.05）, ICU length of stay（P〈0.01） were significant independent risk factors for anxiety. Conclusions Patients in ICU have a high incidence of psychological problems. Patients who have heavy primary disease, psychiatric symptoms during admission or long length of stay are easy to be anxious after discharge; heavy primary disease, higher APACHEⅡ score, psychiatric and delirium symptoms during admission, long length of stay were significant independent risk factors for anxiety of patients discharged from ICU.