儿童青少年脑外伤所致精神障碍远期调查及其与成年人的比较分析

Analysis the prevalence of long-term mental disorders in children and adolescents comparing with adults following traumatic brain injury.

目的探讨儿童青少年脑外伤后4～10年远期器质性精神障碍的发生率及其与成年人的差异。方法对深圳市39家医院的脑外伤病例进行系统抽样,采用自编的《颅脑外伤后精神障碍状况调查手册》对抽样的105例脑外伤儿童青少年患者的精神障碍进行随访调查,并与同期调查的570例成人脑外伤患者进行比较。由二名副主任及以上职称的精神科医师面检筛查阳性者,并按照CCMD-3脑外伤所致精神障碍的诊断标准明确诊断。结果 20.0%(21/105)儿童青少年在调查时符合脑外伤所致精神障碍的诊断,包括:行为(人格)改变12.38%(13/105),智能损害8.57%(9/105),脑外伤后综合征6.67%(7/105),抑郁综合征1.90%(2/105)。重型脑外伤所致精神障碍发生率显著高于中型和轻型(2=8.08,P<0.05;2=20.43,P<0.01)。儿童青少年组颅脑外伤所致远期精神障碍总发生率明显较成人组低(2=6.49,P<0.05),主要是智能损害和抑郁综合征发生率低于成人组(2=6.84,P<0.05;2=6.02,P<0.05)。结论儿童青少年脑外伤对精神损伤的远期影响较成人好。

Objective To explore prevalence of long-term mental disorders of children and adolescents after traumatic brain injury（TBI） during 4-10 year follow up,and to compare with that of adults.Methods System sampling survey of TBI in 39 general hopitals of Shenzhen city of the 105 children and adolescent samples with TBI were screened by self-edit ＂Manua of Psychiatric Consequences After TBI＂.The final diagnoses of mental disorders were determined by two advanced psychiatrists based on CCMD-3 about the criteria of organic mental disorders for brain injury,and the comparison of the outcomes of the survery was made between these patients and 570 adults with TBI.Results Twenty percent（21/105）children and adolescent samples with TBI had met the CCMD-3 diagnosed criteria for one or more oganic mental disorder syndromes including personality or behaviour change（13/105）,intelligent damage（9/105）,neurotic syndrome（7/105） and depressive syndrome（2/105）.The incidence of the mental disorders in the subjects with severe TBI was significantly higher than that of moderate and mild TBI,respectively（54.55% vs 16.67% and 4.76%;X2=22.56,P0.01）.The prevalence of long-term mental disorders of children and adolescents was significantly lower than that of adults（X2=6.49,P0.05）,and the prevalence of intelligent damage and depressive syndrome of children and adolescents was particularly lower than that of adults（X2=6.84,P0.05;X2=6.02,P0.05）.Conclusions The prognosis of long-term mental demage are better in children and adolescents than in adults after TBI.