基層綜合醫院自殺未遂患者精神科會診的調查分析

翁小娟 陳禮賢 吳福斌

[摘要] 目的 了解綜合醫院自殺未遂患者的精神科會診狀況。 方法 以2017年1月1日～2019年8月31日期間溫嶺和玉環兩家綜合性醫院收治的以過量服藥或服農藥自殺未遂住院患者為研究對象，試圖了解自毒自殺未遂患者精神科會診情況及影響因素。 結果 本次調查共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%患者報告有精神心理疾病史，144例患者在入院時被接診醫生詢問自毒原因，住院期間請精神科會診的有45例，占16.1%;出院時提示院外精神科門診隨診的有62例;所有患者出院后1個月內到精神科隨診的有45例，占總調查人群的16.1%。相比較而言，有既往相關病史或入院時被詢問自毒原因更可能得到精神科會診，且差異有顯著性（P<0.05）;有既往相關病史或住院期間精神科會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）。 結論 自毒患者的精神科會診率、院外精神科隨診率較低，入院接診醫生對自毒患者的心理因素關注度可提高精神科會診率，精神科會診又與院外精神科隨診密切相關。

[關鍵詞] 綜合性醫院;自殺;聯絡會診;再自殺干預

[中圖分類號] R749 ? ? ? ? ?[文獻標識碼] B ? ? ? ? ?[文章編號] 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，是啟動再自殺干預和預防的重要環節[17-19]。綜合以上研究結果，現病史的描述和既往史均會提示有高精神科會診率，而高會診率又會帶來高的精神科隨診率，因此需要提高醫務人員特別是急診科、內科、全科醫學醫生對于自毒患者精神心理因素的關注度和識別能力，如本研究所示，自殺干預和預防可以從現病史問診時即可啟動。當然精神科提高自己的會診服務也是非常大的挑戰，目前很多綜合性醫院精神科均存在人員不足、會診量過大的問題[15，20]。如果綜合醫院建立自殺未遂如自服藥物中毒的標準診治流程、單病種質量監控系統、網絡登記及隨訪制度，可能會更有效的降低自殺未遂和自殺死亡率[6，17，19，20]。

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（收稿日期：2019-12-16）