| Objective:To investigate the occurrence of posttraumatic stress disorder（PTSD）symptoms in patients with acute type A aortic dissection（AAAD）,and to identify the risk factors for PTSD symptoms development in AAAD patients of different sexes.To build the PTSD symptom risk predictive model for different sex AAAD patients,which can help medical staff identify high-risk patients at an early stage,and can carry out necessary interventions timely.Methods:A prospective cohort study design was chosen in this study.AAAD patients with informed consent and confidentiality at a provincial heart medical center from September 2017 to June 2019 were enrolled in this study.Self-made data survey scale,Connor-Davidson Resilience Scale（CD-RISC）,Social Support Rating Scale（SSRS）and Hospital Anxiety and Depression Scale（HADS）were used to evaluate AAAD patients before they discharged from hospital.And Posttraumatic Stress Disorder Checklist-Civilian Version（PCL-C）were performed in AAAD patients discharged from hospital after three months.All data was analyzed by SPSS24.0 software.Statistical methods include descriptive analysis,t-test,chi-square test,analysis of variance,non-parametric test,correlation analysis and regression analysis.Results:1.224 patients with AAAD surgery had a 21.4%incidence of PTSD symptoms.The total score of PTSD symptoms in patients with AAAD surgery ranged from 17 to76,with an average score of 27.16±10.98.Among them,the average score of each item in the re-experience dimension was（1.67±1.03）.The average score of the avoidance/numbness dimensions was 1.45±0.90.The average score of each item in the increased alertness dimension was 1.74±1.15.The symptoms of PTSD in patients undergoing AAAD surgery were mainly re-experiencing symptoms and increased alertness.2.Multiple stewards regression results showed that HASD-D（X1）,gender（X2）and optimism（X3）were the main factors influencing PTSD symptoms in patients with AAADsurgery,andthefinalregressionequationwas Y^=39.333+1.621X1-7.539X2-0.920X3.The F value of the regression equation was10.430,with statistical difference（P<0.001）.3.For the male patients with AAAD,PTSD symptoms were significantly positively associated with HADS-D score（P=0.001）,while those with university education and above（P=0.041）,stronger support availability（P=0.004）and greater optimism（P=0.001）had significantly lower possibility for the presence of PTSD symptoms.For the female patients with AAAD,objective support（P=0.027）and HASD-D（P=0.027）was significantly negatively associated with PTSD symptoms4.A nomogram model that can accurately predict the risk of PTSD symptoms in male AAAD patients was constructed,with a c-index value of 0.878 and a better calibration curve.A nomogram model can accurately predict the risk of PTSD symptoms in female AAAD patients was also constructed,with a c-index value of0.973 and a better calibration curve.Conclusion:Emergency surgery for AAAD is associated with a high risk for PTSD,which were associated with depressive symptoms,sex,and optimism.Risk factors for PTSD symptoms differ in male patients and female patients following AAAD,suggesting that clinical medical staff should focus on sex when conducting psychological intervention for AAAD patients and achieve personalized intervention.In addition,the nomogram model for predicting the risk of PTSD symptoms in patients with AAAD of different sexes constructed in this study can make a good personalized prediction for patients and guide the work of medical staff. |
