短暂性脑缺血发作与急性脑梗死患者心理状况的比较

Comparison of psychological status between patients with transient ischemic attack and acute cerebral infarction

目的:比较短暂性脑缺血发作和急性脑梗死患者的心理状况、应对方式及两者之间的关系。方法:选择2003-07/2004-07哈尔滨医科大学第一临床医学院收治的短暂性脑缺血发作患者85例,急性脑梗死患者88例,采用心理状况问卷(共52个条目,包括4个维度:主观健康感30分,无能为力感30分,沮丧感30分,社交障碍感15分,评分越高说明以上感觉越强烈)调查患者的心理状况。采用医学应对问卷犤共20个条目,包括面对(20分),回避(20分),屈服(10分)3个分量表犦测评患者的应对方式,同时探讨心理状况与应对方式的关系。结果:收回完整合格的问卷173份。①患者心理状况问卷得分:短暂性脑缺血发作患者主观健康感得分高于急性脑梗死患者(24.08±7.23,18.35±5.84,t=-2.535,P=0.000),无能为力感和沮丧感得分低于急性脑梗死患者(28.64±5.09,29.95±4.55;20.12±3.86,24.08±4.27,P<0.05)。②医学应对问卷得分:短暂性脑缺血发作组患者回避量表得分高于急性脑梗死患者,屈服量表得分低于急性脑梗死患者(16.23±4.08,14.76±3.55;7.95±3.40,9.83±4.13,P<0.05)。③心理状况与应对方式的关系:短暂性脑缺血发作患者的自主健康感,无能为力感得分与面对及回避应对方式相关(r=0.739,P<0.05,);沮丧感和社交障碍感得分与屈服应对方式相关(r=0.687,P<0.05)。急性脑梗死患者的自主健康感,无能为力感、沮丧感和社交障碍感均与屈服应对方式相关(r=0.837,P<0.001);无能为力感得分与回避应对方式相关(r=0.825,P<0.01,).结论:急性脑梗死患者心理状况较差,比短暂性脑缺血发作患者需要更多的心理支持,对短暂性脑缺血发作和急性脑梗死患者应采取不同的应对方式干预。

AIM： To compare the psychological status and coping style between patients with transient ischemic attack and acute cerebral infarction, and analyze the association between the psychological status and coping style. METHODS： Eighty-five patients with transient ischemic attack and 88 patients with acute cerebral infarction in the First Clinical Medical College of Harbin Medical University between July 2003 and July 2004 were involved in the study. Their psychological status was assessed with the psychological status questionnaire [consisted of 52 items, including 4 dimensions of feeling of subjective health （30 points）, powerless feeling （30 points）, feeling of discouragement （30 points） and feeling of social disability （15 points）; the higher the scores, the stronger the above feelings. Their coping styles were evaluated with the medical coping modes questionnaire [consisted of 20 items, including 3 subscales of facing （20 points）, avoidance （20 points） and withdrawal （I0 points）. The association between psychological status and coping styles was investigated. RESULTS： Totally 173 complete and qualified questionnaires were collected back. ① The scores of psychological status questionnaire： The score of feeling of subjective health in the patients with transient ischemic attack was higher than that in the patients with acute cerebral infarction （24.08±7.23, 18.35±5.84, t=-2.535, P = 0.000）, but the scores of powerless feeling and feeling of discouragement were lower than those in the patients with acute cerebral infarction （28.64：1：5.09, 29.95 ±4.55; 20.12：1：3.86, 24.08：1：4.27, P 〈 0.05）. （±） The scores of medical coping modes questionnaire： The patients with transient ischemic attack had high- er score of avoidance subscale and lower score of withdrawal subscale than the patients with acute cerebral infarction （16.23±4.08, 14.76±3.55; 7.95±3.40, 9.83±4.13, P 〈 0.05）. （±） Association between psychological status and coping styles： In the patients with transient ischemic attack, the scores of feeling of subjective health and powerless feeling were correlated with the facing and avoidance coping styles （r=0.739, P 〈 0.05）, and the scores of feeling of discouragement and feeling of social disability were correlated with the coping style of withdrawal （r=0.687, P 〈 0.05）. In the patients with acute cerebral infarction, the scores of feeling of subjective health, powerless feeling and feeling of social disability were correlated with the coping style of withdrawal （r=0.837, P 〈 0.001）, and the score of powerless feeling was associated with avoidance coping style （r=0.825, P 〈 0.01）. CONCLUSION： Patients with acute cerebral infarction have worse psychological status, so they need more psychological support than those with transient ischemic attack, and they should be given different interventions of coping style.