颅脑外伤后精神障碍发生情况的远期追踪调查

The prevalence of long-term mental disorders following traumatic brain injury

目的 研究颅脑外伤人群在伤后4～13年远期精神障碍的发生情况.方法 对4287例颅脑外伤患者中系统抽样到的675例伤者,采用自编颅脑外伤后精神障碍状况调查手册进行筛查,再由2名副主任以上职称的精神科医师对筛查阳性者,按照CCMD-3中＂脑外伤所致＂各种＂器质性精神障碍＂诊断标准作出明确诊断.结果 ①675例调查对象中符合CCMD-3各种器质性精神障碍诊断标准206例（30.52%,206/675）,其中,智能损害17.48%,遗忘综合征1.04%,人格（或行为）改变13.84%,精神病性症状1.19%,抑郁综合征7.41%,躁狂综合征0.30%,癔症样综合征0.98%,神经症样综合征10.22%.②重型颅脑外伤后精神障碍的发生率（66.01%,134/203）显著高于中型（18.04%,46/255）和轻型（11.98%,26/217）,差异有显著性（χ^2值分别为109.03和129.82,均P〈0.01）.③男性脑外伤后所罹患的人格或行为改变显著高于女性（χ^2=5.65,P〈0.05）,女性脑外伤后罹患神经症样综合征显著高于男性（χ^2=6.02,P〈0.05）.结论 颅脑外伤后远期精神障碍的发生率不容忽视;脑损伤程度越重,精神障碍发生率越高.

Objective To investigate prevalence of long-term mental disorders following traumatic brain injury （TBI） in 4 ～ 13 years. Methods Of the 4287 patients with traumatic brain injury by systematic sampling.675 subjects were screened by the manual of the psychiatric consequences following traumatic brain injury. The final diagnoses of mental disorders were determined by two advanced psychiatrists based on CCMD-3 on the criteria of organic mental disorders. Results ① Of the 675 subjects with traumatic brain injury,206 had satisfied diagnosed criteria of one or more organic mental disorder syndromes by CCMD-3, and with dementia 17.48% , amnestic syndrome 1. 04% , personality or behaviour change 13. 84% , psychotic syndrome 1. 19% , depressive syndrome 7.41% ,manic syndrome 0.30% ,hysteric syndrome 0.98% , neurotic syndrome 10. 22%. ②The incidence of the mental disorders in the subjects with severe TBI was significantly higher than that of moderate and mild TBI,separately 66.01% （134/203） ,18.04% （46/255） and 11.98% （26/217 ）,χ^2=109.03 and 129.82 separately（P〈 0.01）. ③The incidence of the personality or behaviour change in male was significantly higher than that of female, separately 15.31% and 6.98% （χ^2 =5.65, P〈0.05）. The incidence of the neurotic syndrome in female was significantly higher than that of male, separately 15. 12% and 8. 55% （χ^2 = 6. 02, P 〈 0.05）. Conclusion The high incidence of the mental disorders in the patients with TBI should not neglect. There are more high occurrence rate with more severe degree of brain injuries.