基層綜合醫(yī)院自殺未遂患者精神科會(huì)診的調(diào)查分析

翁小娟 陳禮賢 吳福斌

[摘要] 目的 了解綜合醫(yī)院自殺未遂患者的精神科會(huì)診狀況。 方法 以2017年1月1日～2019年8月31日期間溫嶺和玉環(huán)兩家綜合性醫(yī)院收治的以過(guò)量服藥或服農(nóng)藥自殺未遂住院患者為研究對(duì)象，試圖了解自毒自殺未遂患者精神科會(huì)診情況及影響因素。 結(jié)果 本次調(diào)查共280例自毒患者納入研究，男148例，女132例，自毒人群集中于中老年人群，平均年齡（49.3±20.5）歲，只有40%患者報(bào)告有精神心理疾病史，144例患者在入院時(shí)被接診醫(yī)生詢問(wèn)自毒原因，住院期間請(qǐng)精神科會(huì)診的有45例，占16.1%;出院時(shí)提示院外精神科門診隨診的有62例;所有患者出院后1個(gè)月內(nèi)到精神科隨診的有45例，占總調(diào)查人群的16.1%。相比較而言，有既往相關(guān)病史或入院時(shí)被詢問(wèn)自毒原因更可能得到精神科會(huì)診，且差異有顯著性（P<0.05）;有既往相關(guān)病史或住院期間精神科會(huì)診或出院被提示精神科隨診的患者更可能出院后到精神科就診，且差異有顯著性（P<0.05）。 結(jié)論 自毒患者的精神科會(huì)診率、院外精神科隨診率較低，入院接診醫(yī)生對(duì)自毒患者的心理因素關(guān)注度可提高精神科會(huì)診率，精神科會(huì)診又與院外精神科隨診密切相關(guān)。

[關(guān)鍵詞] 綜合性醫(yī)院;自殺;聯(lián)絡(luò)會(huì)診;再自殺干預(yù)

[中圖分類號(hào)] R749 ? ? ? ? ?[文獻(xiàn)標(biāo)識(shí)碼] B ? ? ? ? ?[文章編號(hào)] 1673-9701（2020）15-0166-04

Investigation and analysis on psychiatric consultation in patients with suicide attempt in primary general hospitals

WENG Xiaojuan1 ? CHEN Lixian2 ? WU Fubin3 ? ZHOU Chaoyun1 ? YE Jianhua4 ? FANG Chunyang5

1.Department of Psychiatry，the First People's Hospital of Wenling City in Zhejiang Province，Wenling ? 317500，China;2.Department of Psychiatry，the Second People's Hospital of Yuhuan City ?in Zhejiang Province，Yuhuan ? 317605，China;3.Department of General Practice Medicine，the First People's Hospital of Wenling City in Zhejiang Province，Wenling ? 317500，China;4.Medical Record Room，the First People's Hospital of Wenling City in Zhejiang Province，Wenling ? 317500，China;5.Department of Quality Control，the First People's Hospital of Wenling City in Zhejiang Province，Wenling ? 317500，China

[Abstract] Objective To understand the psychiatric consultation status of patients attempting suicide in general hospitals. Methods Patients who attempted suicide with drug overdosing or pesticide taking were admitted to two general hospitals in Wenling and Yuhuan City from January 1，2017 to August 31，2019. They were selected as the research subjects. The psychiatric consultation status and influencing factors of patients attempting suicide with poisons were attempted to understand. Results A total of 280 patients with self-poisoning were included in the survey，including 132 females and 148 males. The self-poisoning population was concentrated in the middle-aged and elderly population，with an average age of（49.3±20.5）years old. Only 40% of patients were reported to have histories of mental illness. 144 patients were asked about the cause of self-poisoning by their attending doctors upon admission. During hospitalization，45 patients were given psychiatric consultation，accounting for 16.1% of the total; 62 patients were informed of attending follow-up visits at the outpatient psychiatric clinic upon discharge; there were 45 patients who attended follow-up visits in the department of psychiatry within one month after discharge，accounting for 16.1% of the total survey population. In comparison，psychiatric consultation was more likely to be carried out for the patients with a history of related medical conditions or those who were asked about the cause for self-poisoning upon admission，and the differences were significant（P<0.05）; patients with past medical history，those receiving psychiatric consultation during hospitalization，or those informed of attending follow-up visits at the psychiatric clinic upon discharge were more likely to attend visits at the department of psychiatry after discharge，and the differences were significant. Conclusion The rate of psychiatric consultation and out-of-hospital psychiatric follow-up rate in the patients with self-poisoning are relatively low. Admitting doctors' attention to the psychological factors of patients with self-poisoning can increase the rate of psychiatric consultation，which is then closely related to out-of-hospital psychiatric follow-up visits.

自殺未遂者在出院后2～3年再自殺率高[14，16]，因此首次自殺未遂入院后，是啟動(dòng)再自殺干預(yù)和預(yù)防的重要環(huán)節(jié)[17-19]。綜合以上研究結(jié)果，現(xiàn)病史的描述和既往史均會(huì)提示有高精神科會(huì)診率，而高會(huì)診率又會(huì)帶來(lái)高的精神科隨診率，因此需要提高醫(yī)務(wù)人員特別是急診科、內(nèi)科、全科醫(yī)學(xué)醫(yī)生對(duì)于自毒患者精神心理因素的關(guān)注度和識(shí)別能力，如本研究所示，自殺干預(yù)和預(yù)防可以從現(xiàn)病史問(wèn)診時(shí)即可啟動(dòng)。當(dāng)然精神科提高自己的會(huì)診服務(wù)也是非常大的挑戰(zhàn)，目前很多綜合性醫(yī)院精神科均存在人員不足、會(huì)診量過(guò)大的問(wèn)題[15，20]。如果綜合醫(yī)院建立自殺未遂如自服藥物中毒的標(biāo)準(zhǔn)診治流程、單病種質(zhì)量監(jiān)控系統(tǒng)、網(wǎng)絡(luò)登記及隨訪制度，可能會(huì)更有效的降低自殺未遂和自殺死亡率[6，17，19，20]。

[參考文獻(xiàn)]

[1] 呂軍城，王瑩瑩，卓來(lái)寶，等. 急診及住院自殺未遂者危險(xiǎn)因素的病例對(duì)照研究[J].中國(guó)心理衛(wèi)生雜志，2019， 33（2）：81-86.

[2] Jiang CL，Li XY，Michael R，et al. Matched case-control study of medically serious attempted suicides in rural China[J]. Shanghai Archives of Psychiatry，2013，25（1）：22-30.

[3] 肖春玲，李獻(xiàn)云，張艷萍，等. 服農(nóng)藥與其他方式自殺未遂者的特征[J]. 中國(guó)心理衛(wèi)生雜志，2011，25（2）：128-133.

[4] 世界衛(wèi)生組織.總干事報(bào)告1998-2003年[R/OL].（2003-5-19）[2010-02-03].http：//whqlib-doc.who.int/hq/2003/DGO_2003_1_chi.pdf＼

[5] Li XY，Xu Dong，Phillips MR，et al. Comparison of the characteristics of suicide attempters treated in general hospitals with and without prior suicide attempts[J]. Chinese Journal of Internal Medicine，2003，42（12）：861-864.

[6] 謝模英，王柳青. 綜合醫(yī)院自殺未遂現(xiàn)況分析[J]. 湖北科技學(xué)院學(xué)報(bào)（醫(yī)學(xué)版），2015，29（4）：367-368.

[7] 汪自周，王佐，程江南，等. 服農(nóng)藥自殺未遂者相關(guān)社會(huì)心理因素研究[J]. 安徽醫(yī)藥，2014，（7）：1311-1313.

[8] 王月華，童永勝，殷怡，等. 陜西農(nóng)村自殺未遂者再次自殺方式的選擇[J]. 中國(guó)神經(jīng)精神疾病雜志，2019，45（7）：427-431.

[9] 張欣旭，劉加海，郭晶，等. 有、無(wú)精神障礙的農(nóng)村老年自殺者的特征比較[J/OL]. 中國(guó)臨床心理學(xué)志，2019，（5）：905-908，904.

[10] Wang Z，Shu D，Dong B，et al. Anxiety disorders and its risk factors among the Sichuan empty-nest older adults：A cross- sectional study[J]. Archives of Gerontology and Geriatrics，2013，56（2）：298-302.

[11] Wang L，Huang YC，Lee SY，et al. Switching suicide methods as a predictor of completed suicide in individuals with repeated self-harm：A community cohort study in northern Taiwan[J]. Aust N Z J Psychiatry，2015，49（1）：65-73.

[12] Zhang J，Li Z. Suicide means used by Chinese rural youths：A comparison between those with and without mental disorders[J]. Journal of Nervous and Mental Disease，2011，199（6）： 410-415.

[13] 王琳琳，賈存顯，邱惠敏，等. 農(nóng)村自殺未遂人群對(duì)自殺行為的認(rèn)知與態(tài)度研究[J].山東大學(xué)學(xué)報(bào)（醫(yī)學(xué)版），2012，50（9）：118-123.

[14] 廉穎，賈存顯，邱惠敏，等. 服農(nóng)藥自殺未遂者社會(huì)心理學(xué)和自殺行為的特征[J]. 山東大學(xué)學(xué)報(bào)（醫(yī)學(xué)版），2012，（11）：113-117.

[15] 翁小娟，陳禮賢，饒高峰. 綜合醫(yī)院住院患者會(huì)診聯(lián)絡(luò)精神病科的研究[J]. 中國(guó)現(xiàn)代醫(yī)生，2015，53（30）：61-64.

[16] 徐東，張學(xué)立，李獻(xiàn)云，等. 自殺未遂者出院后再次出現(xiàn)自殺行為的6年隨訪[J]. 中國(guó)神經(jīng)精神疾病雜志，2011，37（7）：410-412.

[17] 危小虎. 自傷急診就醫(yī)677例分析[J]. 浙江預(yù)防醫(yī)學(xué)，2013，25（8）：44-45，50.

[18] 李海燕，秦曉霞. 自殺未遂再自殺危險(xiǎn)因素及其干預(yù)的研究進(jìn)展[J]. 國(guó)際精神病學(xué)雜志，2008，35（2）：122-125.

[19] 丁小萍，胡德英，萬(wàn)青，等. 綜合醫(yī)院非精神科住院病人自殺行為預(yù)測(cè)ARIMA模型的構(gòu)建及其應(yīng)用[J]. 護(hù)理研究，2019，（19）：3302-3307.

[20] 朱秀琴，陸麗娟，余媛，等.根本原因分析法在綜合醫(yī)院住院患者自殺事件預(yù)防中的運(yùn)用[J]. 護(hù)理管理雜志，2015，15（8）：594-596，608.

（收稿日期：2019-12-16）