烧伤患者可疑急性创伤后应激障碍及其相关因素分析

Probable acute posttraumatic stress disorder and the related factors after burn injury

目的:采用创伤后应激障碍筛查量表探讨烧伤患者可疑创伤后应激障碍的发生率及其相关因素。方法:于2003-05/2004-07作者收集了大连市大化医院和鞍山市烧伤医院烧伤入院患者100例作为调查对象。所有对象在入院第10天接受调查。采用自制一般问卷进行一般情况的调查;采用症状自评量表评定心理健康状况;采用艾森克人格问卷评估人格特征(神经质、内外向、精神质、掩饰);采用领悟社会支持量表评定对社会支持的感受程度(家庭内、家庭外);采用生活事件量表评定烧伤前一年对生活事件的判断情况(正性、负性);采用特质应对方式问卷调查应对方式(积极、消极)。在入院1个月时,接受创伤后应激障碍筛查量表测查,并进行与美国精神疾病诊断与统计手册第4版创伤后应激障碍的诊断及各量表、问卷的符合性判定,采用Logistic逐步回归分析创伤后应激障碍筛选列表阳性者的危险因素。采用t检验分析症状自评量表评分与常模的比较,烧伤患者的创伤后应激障碍筛阳性与阴性者之间的人格差别,社会支持差异,应对方式差异;采用χ2检验分析创伤后应激障碍筛选列表阳者的婚姻、烧伤部位、支付、性别和担心等多个方面的差别。结果:18例因各种原因脱落,完成所有问卷者82例。①经创伤后应激障碍筛选列表筛选,可疑急性创伤后应激障碍阳性者19例,占烧伤人数的23%;符合急性创伤后应激障碍筛诊断14例,占烧伤人数的17%。②急性创伤后应激障碍患者症状自评量表的躯体化、焦虑和偏执因子明显高于常模(P<0.05)。③创伤后应激障碍筛选列表检出阳性患者与检出阴性患者比较,艾森克人格问卷中的神经质、内向得分、精神病质评分更高;应对方式以消极应对为主;生活事件评定对以负性事件为多。④可疑创伤后应激障碍患者与非可疑患者的性别、婚姻状况和付费方式之间无差别(P>0.05);而担心内容(毁容、经济、残疾)和烧伤的部位(非功能区,功能区)各项之间差别显著(P<0.05)。⑤可疑创伤后应激障碍发生的相关因素是烧伤面积、神经质、内向人格、家庭支持、精神病性(P<0.05)。结论:烧伤患者普遍存在抑郁、焦虑、强迫等心理问题,急性创伤后应激障碍的烧伤患者心理问题的发生率更高;可疑性创伤后应激障碍发生的相关因素中,人格因素(神经质、内向得分、精神病质)非常重要。与可疑性创伤后应激障碍的成因关系最密切的可能是烧伤面积、神经质、内向人格、领悟社会支持和精神病质。

AIM： To probe into the incidence rate of probable acute posttraumatic stress disorder （PTSD） after burn injury and related factor by use of PTSD checklist-civilian version （PCL-C）.METHODS：From May 2003 to July 2004, 100 patients with burn injury were collected from Dalian Petrochemical Hospital and Anshan Burn Hospital. On the 10th day after admission, all the patients were investigated with self-designed questionnaire, symptom checklist-90 （SCL-90）, Eysenck personality questionnaire （EPQ）, perceived social support scale （PSSS）, life event scale （LES） and Trait coping style questionnaire （TCSQ）. At one month after admission, they were assessed with PCL-C. The risk factors of the patients, who had positive PTSD, were analyzed with the Logistic stepwise regression analysis, made an according diagnosis with DSM-IV. The t test and x^2 test were used.RESULTS： Eighteen patients lost in the study, and 82 patients finished the questionnaire. ① 19 cases （23%） had probable PTSD and met criteria for PCL-C, 14 patients （17%） met criteria for acute PTSD of DSM-Ⅳ. ②The scores of somatization, anxiety and paranoid ideation in SCL-9Owere obviously higher in the PTSD patients than in norms （P 〈 0.05）. ③ There were significant different between the two groups in the negative coping behavior （P 〈 0.05）. Some factors were highly correlated with probable acute PTSD, including of the total body surface area （TBSA-FT）, neurosis, Introversion, psychosis, PSSS and numbers of bed events of LES （P 〈 0.05）. ④ There were no differences between the probable acute PTSD and no in the sex, marry, payment style （P 〉 0.05）; There are significant different between the two groups in the worry （for disfigurement, economy, deformity） and functional part （functional and no） （P 〈 0.05）. ⑤ TBSA-FT, introversion personality, psychosis, loss SPSS score were the risk factors for probable PTSD （P 〈 0.05）.CONCLUSION： There are serious psychological problems in the patients after burn injury, especially depression, anxiety, obsessive-compulsive disorders, etc; and the incidence rate is higher in those with PTSD. Of the related factors for the incidence of probable PTSD, personality factors may be very important, TBSA-FT, introversion personality, psychosis, loss SPSS score are the most closely correlated with probable PTSD.