创伤后应激障碍外科患者自动出院：一个说明独特挑战的病例报告系列
Discharge against Medical Advice in Surgical Patients with Posttraumatic Stress Disorder: A Case Report Series Illustrating Unique Challenges.
作者信息
Brzezinski Marek, Gregersen Maren, Schuch Luiz Gustavo, Sawatzki Ricarda, Chen Joy W, Gauger Grant, Kukreja Jasleen, Cason Brian
机构信息
VA Medical Center, Anesthesia Services, 4150 Clement Street, San Francisco, CA 94121, USA.
Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue Room C-450, San Francisco, CA 94143-0648, USA.
出版信息
Case Rep Anesthesiol. 2017;2017:3045907. doi: 10.1155/2017/3045907. Epub 2017 Jun 21.
Discharge against medical advice (DAMA) can have detrimental effects on patient outcomes. Recently, the diagnosis of posttraumatic stress disorder (PTSD) has been linked with DAMA in the setting. However, PTSD as a risk factor for DAMA in patients has not received much consideration, although such patients may be at risk for triggering or amplification of PTSD symptoms perioperatively. We present the first case report series of three surgical patients with PTSD who left the hospital AMA. These cases differ markedly from DAMA in non-PTSD patients. In all three subjects, the stress of feeling misunderstood by clinicians and the distress of public detainment by hospital security in the setting of chronic PTSD led to aggressive and risky behavior. All three subjects represented a risk to themselves and to others at the time of DAMA. Finally, all three subjects were difficult to contact for follow-up or medical care and missed appointments.
违反医嘱出院（DAMA）可能会对患者的治疗结果产生不利影响。最近，创伤后应激障碍（PTSD）的诊断与这种情况下的违反医嘱出院有关。然而，PTSD作为患者违反医嘱出院的一个风险因素，尚未得到充分考虑，尽管这类患者在围手术期可能有引发或加重PTSD症状的风险。我们首次报告了三例患有PTSD的外科手术患者违反医嘱出院的病例系列。这些病例与非PTSD患者的违反医嘱出院情况明显不同。在所有三个病例中，慢性PTSD患者因感到被临床医生误解而产生的压力以及在医院保安公共拘留情况下的痛苦，导致了激进和危险的行为。在违反医嘱出院时，所有三个病例对自身和他人都构成了风险。最后，所有三个病例都很难联系到进行随访或医疗护理，并且错过了预约。
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