海上灾害严重创伤伤员创伤后应激障碍的防治研究

Study on the prevention and treatment of post traumatic stress disorder in severe trauma patients induced by marine disasters

目的研究海上灾害严重创伤患者创伤后应激障碍（posttraumatic stress disorder，PTSD）水平，并提出有效的防治方法。方法200例海上灾害严重创伤患者分成治疗组（100例）和对照组（100例），对照组采用常规治疗，包括现场急救、手术和纠正高渗、高钠、高氯血症，纠正酸中毒和抗感染；治疗组在常规治疗的基础上，加心理干预及鲁米那（1uminal）和帕罗西汀（paroxetine）药物治疗。观察2组临床治疗结果和PTSD的发生率。结果治疗组与对照组死亡率分别为17％和19％。伤后第1周治疗组与对照组PTSD的发生率分别为65％和69％，伤后第2-5周2组PTSD发生率逐渐降低，治疗组下降率更加明显，伤后第5周治疗组与对照组分别降至4％和19％，2组比较差异有统计学意义（P〈0．01）。结论海上灾害严重创伤患者PTSD发生率较高，早期心理干预与早期防治可明显降低海上灾害严重创伤伤员PTSD的发生率。

Objective To study the seriousness of post traumatic stress disorder （FISD） in severe trauma patients induced by marine disasters, and to recommend effective prevention and treatment proposals. Methods Two hundred severe trauma patients induced by marine disasters were randomly divided into 2 groups, the treatment group （100 cases） and the control group （100 cases）. The control group was given routine treatment, including on-the-site first aid, surgery and correction of electrolyte imbalance, metabolic acidosis and anti-infection. The treatment group was treated with psychological intervention, plus luminal and paroxetine in addition to conventional therapy. Clinical treatment results and positive rates of PTSD were closely observed. Results Mortality for the treatment group was 17% and mortality for the control group was 19%. One week after injury, the positive rate of PISD for the treatment group was 65%, and the rate for the control group was 69%. Two to five weeks after injury, positive rates of PTSD for the2 groups decreased gradually, with the treatment group decreasing more obviously. Five weeks after injury, positive rates of PTSD for the treatment group and the control group decreased to 4% and 19% respectively（P 〈 0.01 ）. Conclusion Incidence of PTSD was high in severe trauma patients, following marine disasters. Early psychological intervention, early prevention and treatment could significantly decrease posi- tive rate of PTSD in severe trauma patients, following marine disasters.