目的 探究创伤重症监护室(trauma intensive care unit，TICU)患者环境压力源感知程度及其影响因素对谵妄进展的影响。方法 采用抽样法选取 2022 年 6 月—2023 年 6 月于山东大学齐鲁医院TICU的 395 例患者为研究对象，采用一般资料调查表、ICU环境压力源量表(intensive care unit environmental stressor scale，ICUESS)进行调查分析患者环境压力源感知程度及其影响因素，采用多元线性回归分析TICU患者环境压力源感对谵妄进展的影响。结果 创伤患者入住TICU期间影响压力感受程度最大的因素分别为疼痛、思念家人，环境压力源总分为(91。48±28。80)分，其中人文环境维度得分最高为(24。03±7。39)分，物理环境维度得分最低(21。82±7。25)分。多元线性回归分析显示，疼痛程度(＞3 分)、监护时间(＞3 d)、肢体约束(是)、镇静(是)、焦虑总分是TICU患者环境压力感受程度的影响因素(P＜0。05)。有98 例患者发生亚谵妄，89 例发生谵妄，发生率分别为 24。8%、22。5%，发生亚谵妄患者环境压力源感知程度介于无谵妄与完全谵妄之间。结论 TICU患者感受到的环境压力源感知程度处于较高的水平，疼痛程度较大、监护时间长、采取约束措施、镇静措施、焦虑程度较大的患者环境境压力源感知程度越重。监护室环境压力源感知程度越重的患者更易发生亚谵妄和谵妄，发生谵妄患者的压力源感知程度高于亚谵妄患者。护理人员应针对影响因素采取精准的干预措施，降低TICU患者对环境压力源的感知程度，减少患者亚谵妄及谵妄的发生，改善患者预后。
The Impact of Perceived Levels of Environmental Pressure and Their Influencing Factors on the Progression of Delirium in Trauma Intensive Care Unit Patients
Objective To explore the perception of environmental stressors in trauma intensive care unit(TICU)patients,analyze its influencing factors and its impact on subsyndromal delirium and delirium.Methods A total of 395 patients in TICU of Qilu Hospital of Shandong University from January to December 2022 were selected by convenience sampling method.The general data questionnaire and ICU stressor scale(ICUESS)were used for investigation and analysis its influencing factors.The impact of environmental stressors on delirium progression in TICU patients was investigated using multiple linear regression analysis.Results Pain and missing family members were the most important factors affecting the stress perception of trauma patients during their stay in TICU.The total score of environmental stressors was(91.48±28.80)points,of which the highest score was(24.03±7.39)points in the humanistic environment dimension and the lowest score was(21.82±7.25)points in the physical environment dimension.Multivariate linear regression analysis showed that the degree of pain(>3 points),monitoring time(>3 days),limb restraint(yes),sedation(yes),and total anxiety score were the influencing factors of the degree of environmental stress in trauma patients(P<0.05).There were 98 patients with sub-delirium and 89 patients with delirium,the incidence rates were 24.8％and 22.5％,respectively.The degree of environmental pressure perception in patients with subsyndromal delirium was between non-delirium and complete delirium.Conclusion The degree of environmental stress perception of trauma patients after admission to TICU is at a high level.Patients with severe pain,long monitoring time,restraint,sedation and anxiety have a higher degree of environmental stress perception.Patients with more severe pressure perception in the intensive care unit are more likely to have subsyndromal delirium and delirium,and the degree of pressure perception in patients with delirium is higher than that in patients with subsyndromal delirium.Nursing staffshould take precise intervention measures according to the influencing factors,reduce the patient's perception of the ring static pressure of TICU,reduce the occurrence of subsyndromal delirium and delirium,and improve the prognosis of patients.
trauma patientsintensive care unitperception of environmental stresssubsyndromal deliriumdeliriumimpact
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