CAJ | 학술논문

目的：了解重症监护室(ICU)内科患者直系亲属的心理状态及变化,为ICU患者的家属管理提供依据。方法连续性选择2013年1~12月于上海市嘉定区中心医院ICU住院的内科患者的直系家属166名,在患者入院72 h后,记录其直系亲属症状自评量表(SCL-90)分值,比较各症状因子症状指数与常模的差异；根据不同性别分为男性组(n=121)和女性组(n=45),根据不同年龄分为非老年组(n=107)和老年组(n=59),分别比较各因子症状指数及总分的差异。结果患者直系亲属SCL-90量表评分总分高于国内常模(P<0.05),各项症状因子,除人际敏感、恐惧及精神病性外,其他因子分值均显著增高(P<0.01)；男性的强迫心理[(2.26±0.31)比(2.39±0.34)分,P=0.021]、抑郁[(2.33±0.34)比(2.53±0.36)分,P=0.001]、焦虑[(2.63±0.29)比(2.76±0.34)分,P=0.018)]及总分[(179.17±18.05)比(186.98±19.34)分,P=0.016]显著低于女性家属,而偏执表现显著高于女性[(2.13±0.36)比(1.95±0.35)分,P=0.003]；非老年人躯体化水平[(1.88±0.25)比(1.95±0.27)分,P=0.034]、强迫[(2.25±0.31)比(2.38±0.32)分,P=0.014]、偏执[(2.03±0.33)比(2.17±0.40)分,P=0.023]分值显著低于老年人,而焦虑[(2.71±0.30)比(2.59±0.32)分,P=0.016]、敌对[(1.90±0.31)比(1.79±0.21)分,P=0.015]显著高于老年人。结论 ICU内科患者的直系亲属在其入院后,容易发生负面的心理变化。在ICU的家属管理方面,应重视不同性别、不同年龄的家属心理状态的不同,有针对性及有侧重点地进行护患沟通,以减少护患矛盾及改善患者家属的心理障碍。
목적：료해중증감호실(ICU)내과환자직계친속적심리상태급변화,위ICU환자적가속관리제공의거。방법련속성선택2013년1~12월우상해시가정구중심의원ICU주원적내과환자적직계가속166명,재환자입원72 h후,기록기직계친속증상자평량표(SCL-90)분치,비교각증상인자증상지수여상모적차이；근거불동성별분위남성조(n=121)화녀성조(n=45),근거불동년령분위비노년조(n=107)화노년조(n=59),분별비교각인자증상지수급총분적차이。결과환자직계친속SCL-90량표평분총분고우국내상모(P<0.05),각항증상인자,제인제민감、공구급정신병성외,기타인자분치균현저증고(P<0.01)；남성적강박심리[(2.26±0.31)비(2.39±0.34)분,P=0.021]、억욱[(2.33±0.34)비(2.53±0.36)분,P=0.001]、초필[(2.63±0.29)비(2.76±0.34)분,P=0.018)]급총분[(179.17±18.05)비(186.98±19.34)분,P=0.016]현저저우녀성가속,이편집표현현저고우녀성[(2.13±0.36)비(1.95±0.35)분,P=0.003]；비노년인구체화수평[(1.88±0.25)비(1.95±0.27)분,P=0.034]、강박[(2.25±0.31)비(2.38±0.32)분,P=0.014]、편집[(2.03±0.33)비(2.17±0.40)분,P=0.023]분치현저저우노년인,이초필[(2.71±0.30)비(2.59±0.32)분,P=0.016]、활대[(1.90±0.31)비(1.79±0.21)분,P=0.015]현저고우노년인。결론 ICU내과환자적직계친속재기입원후,용역발생부면적심리변화。재ICU적가속관리방면,응중시불동성별、불동년령적가속심리상태적불동,유침대성급유측중점지진행호환구통,이감소호환모순급개선환자가속적심리장애。
Objective To investigate the psychological state and the trends of the immediate family members of medical patients in ICU, in order to provide basis for management of ICU patients' family members. Methods A total of 166 cases from January to December 2013 were enrolled the study. The symptom checklist-90 (SCL-90) scores of the im-mediate family members of the patients were recorded when the patients into ICU after 72 hours. Differences of symp-tom index between each symptom factors and conventional model were compared. The all cases were divided into two groups, male group (n=121) and female group (n=45) based on their gender. Then the all cases were divided into non-aged group (n=107) and aged group (n=59) according to the age more than 60 years or not. The symptom index differ-ences in the groups were compared. Results The total score of SCL-90 in the immediate family members was signifi-cantly higher than that in the conventional model (P<0.01). Almost all the symptom factors increased except interper-sonal sensitive, fear and psychoticism (P<0.05). Obsessive-compulsive disorder [(2.26±0.31) vs (2.39±0.34) points, P=0.021], depression [(2.33±0.34) vs (2.53±0.36) points, P=0.001], anxiety [(2.63±0.29) vs (2.76±0.34) points, P=0.018] and total score [(179.17±18.05) v s (186.98±19.34) points, P=0.016] were significantly lower in male group, while para-noid [(2.13±0.36) v s (1.95±0.35) points, P=0.003] was higher than that in the female group. Somatization [(1.88±0.25) v s (1.95±0.27) points, P=0.034], obsessive-compulsive disorder [(2.25±0.31) v s (2.38±0.32) points, P=0.014], paranoid [(2.03±0.33) vs (2.17±0.40) points, P=0.023] were significantly lower in non-aged group, while anxiety [(2.71±0.30) vs (2.59±0.32) points, P=0.016)] and hostility [(1.90±0.31) vs (1.79±0.21) points, P=0.015] were higher than those in aged group. Conclusion The immediate family members are prone to negative psychological changes, when the patients after admission to ICU. For the dependents management in the ICU, it should attach importance to the differences of gender and age. Nurse-patient communication should be targeted and focuses based on the gender and age, thus reduce the contradiction between nurses and patients, and amelio-rate the psychological barriers of the dependents.