创伤住院患者急性应激障碍及影响因素的调查研究

Investigation on acute stress disorder and related risk factors in hospitalized trauma patients

目的调查创伤住院患者急性应激障碍(acute stress disorder,ASD)的发生情况,及其与疼痛、人格特征、社会支持及应对方式的关系。方法采用斯坦福急性应激障碍量表、疼痛视觉模拟评分法、社会支持评定量表、简易应对方式问卷和艾森克人格问卷对重庆市3所三甲医院的289例创伤住院患者进行问卷调查。结果①创伤住院患者急性应激障碍阳性率为12.46%。289例患者中有分离症状的60例(20.76%),有焦虑或警觉性增高症状的137例(47.40%),有回避症状的45例(15.57%),有创伤再体验症状的67例(23.18%);女性较男性更易发生ASD(P<0.05)。②斯坦福急性应激障碍量表总分与疼痛评分、神经质评分呈正相关(r=0.532 2、0.445 1,P<0.05),与内外向、主观社会支持、积极应对方式呈负相关(r=-0.340 2、-0.659 1、-0.409 7,P<0.01,0.05)。③ASD阳性组在疼痛视觉模拟评分、人格问卷N量表及消极应对因子上得分高于ASD阴性组(P<0.05,P<0.01);而在主观支持、支持利用度、积极应对方式及E量表上的得分低于ASD阴性组(P<0.01)。结论创伤住院患者急性应激症状较明显,疼痛感受强、偏内向不稳定的人格特征是影响ASD发生的重要因素。

Objective To investigate the clinical features and risk factors of acute stress disorder（ASD） in hospitalized patients after traumatic injury.Methods A total of 311 patients were enrolled from three 3 A grade hospitals of Chongqing from March 2011 to June 2011 and were tested with Stanford Acute Stress Reaction Questionnaire（SASRQ）,Visual Analogue Scale/Score（VAS）,Social Support Review Survey（SSRS）,Simplified Coping Style Questionnaire（SCSQ） and Eysenck Personality Questionnaire-Revised Short Seale for Chinese（EPQ-RSC）.Two hundred and eighty-nine valid questionnaires were obtained.Results（1） The positive rate of ASD in trauma patients was 12.46%.The 289 patients included 20.76% of dissociative symptoms,47.4% of anxiety or neuroticism,15.57% avoidance symptoms and 23.18% of trauma recapture symptoms;the female patients were more likely to have ASD than male patients（P〈0.05）.（2） The total score of SASRQ was positively correlated with VAS and neuroticism scores of EPQ-RSC,and the correlation coefficients were 0.532 2 and 0.445 1,respectively.The total score of SASRQ was negatively correlated with extraversion,perceived social support and positive coping style,and the correlation coefficients were-0.340 2,-0.659 1 and-0.409 7,respectively.（3） The VAS,N scale of EPQ-RSC and negative coping style were higher in the ASD-positive group than in the ASD-negative group（P〈0.05,P〈0.01）,while the perceived support,support utilization,positive coping style and E scale were lower in the ASD-positive group than in the ASD-negative group.Conclusion Hospitalized trauma patients have a relatively high occurrence of ASD,which is associated with strong sense of pain and partial introverted unstable personality.Psychological interventions should be provided as early as possible especially for female trauma patients and patients with severe injury.