肝胆外科患者术后失眠原因的多因素分析.docVIP

肝胆外科患者术后失眠原因的多因素分析 　　作者：许丽丽，谢 峰，杨甲梅，朱丽君，熊正香 　　[摘要] 目的 探讨肝胆外科患者术后失眠的可能原因。方法 采用自定的影响失眠相关因素调查表对我院2005年10月～2006年5月特需科连续收治100例手术患者进行问卷调查。所有数据输入SAS 9.1.3软件包，运用多分类有序反应变量Logistic回归分析进行统计学分析。分别将失眠天数和术前/术后睡眠的时间的差值作为反应变量。结果 焦虑优势比(odds ration，2.259)，95%可信区间(1.019，5.007)，说明焦虑是影响因素。术前睡眠时间的优势比(odds ration，0.246)，95%可信区间(0.151，0.400)，是保护因素。经济情况顾虑的优势比(odds ration，3.873)，95%可信区间(1.203，12.467)，是影响因素。结论 焦虑患者比不焦虑患者术后失眠天数更长。术后失眠严重的程度主要与术前睡眠的时间和对经济情况顾虑有关。 　　[关键词] 肝胆外科;失眠;术后护理 　　Multi-factors analysis of hepatobiliary surgery patients with insomnia after operation 　　XU Li-li,XIE Feng,YANG Jia-mei,et al.Eastern Hepatobiliary Surgery Hospital,Shanghai 200438,China 　　[Abstract] Objective To investigate the insomnia and related factors among hepatobiliary surgery patients.Methods With se1f-designed sleeping influence factors questionnaire，from Oct 2005 to May 2006,100 continuous hepatobiliary surgery patients in our department were investigated.Multi-response variable logistic regression analysis had been used to analyze the data by SAS 9.1.3.The insomnia days and the difference of bedtime between pre-operation and post-operation were regarded as response variable.Results Anxiety had been evaluated to be related to insomnia(odds ration，3.873).The hours of sleep preoperation had been evaluated to be related to sleep quality(odds ration，0.246).The economic factor had been evaluated to be related to insomnia(odds ration,3.873).Conclusion The more anxiety,the patients have more insomnia time after operation.The hours of sleep before operation and economic factor are concerned with the severity of insomnia. 　　[Key words] hepatobiliary surgery;insomnia;post-operation nursing 　　失眠通常指患者对睡眠时间和(或)质量不满足并影响白天社会功能的一种主观体验。临床常见的失眠形式有(1)睡眠潜伏期延长：入睡时间30 min;(2)睡眠维持障碍：夜间觉醒次数≥2次或凌晨早醒;(3)睡眠质量下降：睡眠浅、多梦;(4)总睡眠时间缩短：通常6 h;(5)日间残留效应(diurnal residual effects)：次晨感到头昏、精神不振、嗜睡、乏力等[1]。肝胆外科患者术后失眠极为常见，直接影响到肝胆外科患者术后的顺利恢复。因此，调查肝胆外科患者的失眠原因，对提高临床护理工作质量具有重要意义。笔者通过连续收治的100例肝胆外科手术患者的术后睡眠，进行相关因素的多分类有序反应变量L