2024 年第 11 期 第 0 卷

反刍思维在老年脓毒症患者重症监护病房记忆与创伤后应激障碍间的中介效应研究

The mediating effect of rumination thinking between intensive care unit memory and post-traumatic stress disorder in elderly patients with sepsis

作者：张宁1丁巾玲2郝宇丽3赵婧雪1李娅楠4

英文作者：Zhang Ning1 Ding Jinling2 Hao Yuli3 Zhao Jingxue1 Li Yanan4

单位：1中国人民解放军第三〇五医院重症监护室，北京100017；2解放军总医院京西医疗区综合内科，北京100144；3解放军总医院京中医疗区安宁庄门诊部，北京100085；4解放军总医院京西医疗区综合外科，北京100144

英文单位：1Department of Intensive Care Unit the 305 Hospital of the Chinese People′s Liberation Army Beijing 100017 China; 2Department of General Medicine Jingxi Medical Branch of Chinese PLA General Hospital Beijing 100144 China; 3Anning Zhuang Clinic Jingzhong Medical Branch Chinese PLA General Hospital Beijing 100085 China; 4Department of General Surgery Jingxi Medical Branch of Chinese PLA General Hospital Beijing 100144 China

关键词：脓毒症；反刍思维；重症监护病房记忆；创伤后应激障碍；中介效应

英文关键词：Sepsis;Ruminationthinking;Intensivecareunitmemory;Post-traumaticstressdisorder;Mediatingeffect

• 摘要：

• 目的 探讨重症监护病房(ICU)转出的老年脓毒症患者ICU记忆与创伤后应激障碍（PTSD）间的关系，并探讨反刍思维在ICU记忆与PTSD间的中介效应。方法 2020年1月至2023年12月便利抽取中国人民解放军第三〇五医院和解放军总医院第八医学中心从ICU转出的老年脓毒症患者240例为研究对象。采用一般状况调查问卷、汉化版创伤后应激障碍症状自评量表（PCLC）、ICU记忆评估工具（ICUMT）、多维度反刍思维反应量表（MRIS）为调查工具进行横断面调查。分析患者一般资料对反刍思维、ICU记忆、PTSD评分的影响，采用Pearson方法分析三项评分的相关性，采用结构方程模型分析反刍思维在患者ICU记忆与PTSD间的中介效应。结果 存在睡眠障碍者、进行呼吸机辅助通气者、使用镇痛剂者、使用镇静剂者，其三项评分均高于另一组（均P＜0.05）。老年脓毒症患者ICUMT评分与MRIS评分和PCLC评分均存在正相关关系（r=0.550、P＜0.001；r=0.650、P＜0.001），MRIS评分和PCLC评分间同样存在正相关关系（r=0.781、P＜0.001）。ICU记忆对PTSD存在正向影响，直接效应值为0.840；反刍思维对PTSD的正向影响也被证实，直接效应值为0.100；ICU记忆通过影响反刍思维也可对PTSD产生间接影响，效应值为0.329。结论 老年脓毒症患者的ICU记忆对PTSD有直接影响，也可通过反刍思维间接影响。

• Objective To explore the relationship between intensive care unit memory and post-traumatic stress disorder (PTSD) in elderly patients with sepsis transferred from intensive care unit (ICU), and to explore the mediating effect of rumination thinking between ICU memory and PTSD. Methods From January 2020 to December 2023, 240 elderly patients with sepsis transferred from ICU in the 305th Hospital of the Chinese People′s Liberation Army and the Eighth Medical Center, Chinese PLA General Hospital were selected as the research objects. The general status questionnaire, post-traumatic stress disorder symptom checklist-Chinese version (PCLC), the intensive care unit memory assessment tool (ICUMT) and multidimensional rumination response scale (MRIS) were used to conduct a cross-sectional survey.The effects of patients′ general data on rumination thinking, ICU memory and PTSD scores were analyzed. Pearson method was used to analyze the correlation of the three scores, and structural equation model was used to analyze the mediating effect of rumination thinking between ICU memory and PTSD of patients. Results The scores of those with sleep disorders, ventilator assisted ventilation, analgesics, and sedatives were higher than those of the other group (all P＜0.05). There was a positive correlation between ICUMT score and MRIS score and PCLC score in elderly patients with sepsis(r=0.550, P＜0.001; r=0.650, P＜0.001), and there was also a positive correlation between MRIS score and PCLC score (r=0.781, P＜0.001).ICU memory had a positive effect on PTSD, and the direct effect value was 0.840. The positive effect of rumination thinking on PTSD was also confirmed, and the direct effect value was 0.100. ICU memory also had an indirect effect on PTSD by affecting rumination thinking, and the effect value was 0.329. Conclusion ICU memory in elderly patients with sepsis has a direct effect on PTSD, and also an indirect effect through rumination thinking.