汶川地震中极度应激状态对轻度颅脑创伤患者精神健康的影响

Effect of extreme stress on the mental health of patients with mild traumatic brain injury surviving Wenchuan earthquake

目的观察汶川地震中极度应激状态与轻度颅脑创伤早期的相互影响。方法于汶川地区地震灾后2～30d对地震中遭受轻度颅脑创伤的灾民20例（MTBI组）和同期灾区未遭受颅脑创伤的灾民20例（对照组）进行SCL-90心理健康自评量表检测,量表包含躯体化、强迫症状、抑郁、焦虑、敌对、恐怖、人际关系敏感、精神病性、偏执9个症状因子,共有90个题目,按5级评分。结果MTBI组的躯体化、抑郁、焦虑、敌对和恐怖因子分数（分别为2.12±0.50、1.83±0.60、1.99±0.40、1.80±0.70、2.20±0.80）较对照组（分别为1.57±0.42、1.40±0.31、1.75±0.67、1.32±0.31、1.54±0.54）显著增高（P〈0.05）,精神病性、偏执因子分数（分别为1.72±0.30、1.70±0.50）较对照组（分别为1.63±0.53、1.67±0.49）虽有增高趋势,但两组间差异无统计学意义（P〉0.05）。结论伴有轻度颅脑创伤的地震灾民是发生心理障碍的高危人群,地震的心理应激与颅脑创伤相互作用可能导致患者更加复杂且严重的临床症状,因此医务人员在处理此类轻度颅脑创伤患者时要高度重视心理治疗。

Objective To observe the interaction between the extreme stress and mild traumatic brain injury in the patients surviving Wenchuan earthquake. Methods Forty survivors in Wenchuan earthquake were selected for the psychological status survey 2-30 days after the disaster, among them 20 survivors were suffering from mild traumatic brain injury, and the remainders were in normal physical conditions. The Symptom Checklist-90 （SCL-90）, which consisted of 90 items with 5 grades for each item （0-4 grade, grade zero as none and grade 4 as severe）, including 9 symptom factors, was adopted to perform the evaluation for all the subjects in both groups, and the subscales were compared, Results Five subscales of SCL 90, including somatization, depression, anxiety, hostility and fear, which aver aged 2. 12±0. 50, 1. 83±0. 60, 1.99±0. 40, 1.80±0. 70 and 2. 20±0. 8, respectively, were significantly increased in mild traumatic brain injury group than that in control group （P〈0. 05）, among whom they were 1. 57±0.42, 1.40±0. 31, 1.7±90. 67, 1. 32±0. 31 and 1.54±0. 54, respectively. Slight increases without statistical significance were also seen in 2 subscales, including psychiatric disorder and obduracy （1.72±0.30 vs1. 63±0.53, 1.70±0.50 vs1. 67±0.49, P〉0.05）. Conclusions Mild traumatic brain injury occurred among survivors of severe earthquakes is strongly associated with psychological problems. A higher incidence of psychological disorder in survivors of earthquake with mild traumatic brain injury indicates that one must be cautious when attributing a health problem to mild traumatic brain injury, since the post-traumatic stress disorder and depression may be the primary problem. The high-risk population with psychological obstacle consists of the survivors with mild traumatic brain injury, and the interactions of both psychological stress and traumatic brain injury may lead to more complex clinical symptoms, so psychotherapy should be emphasized in the treatment of patients with mild traumatic brain injury.