重度烧伤患者应激障碍的影响因素分析

THE IMPACT FACTOR ANALYSIS OF SEVERE BURN PATIENTS WITH POST-TRAUMATIC STRESS DISORDER

目的探讨重度烧伤住院患者创伤后应激障碍的影响因素。方法对64例重度烧伤住院患者进行人口学、烧伤情况等资料收集,并以医学应对方式问卷(MCMQ)、创伤后应激障碍症状列表-平民版(PCL-C)调查其疾病应对方式和并发PTSD及其核心症状"闪回"、"逃避"、"过度警觉"的情况。以被试患者人口学资料,烧伤情况以及MCMQ评估指标的数据为自变量,PCL-C评估指标的数据为因变量,建立Lo-gistic回归模型考查两类变量之间的因果关系。结果重度烧伤患者"回避"、"屈服"应对行为显著高于一般人群(t分别为7.06,7.76,p<0.01)。46.9%(30/64)患有PTSD症状。被试者并发PTSD与"屈服应对行为"有关(OR分别为10.150,9.333;p<0.01;CI分别为2.149～47.936,1.637～53.208);出现"闪回"症状与"烧伤面积"有关(OR=4.234,p<0.01,CI=1.535～11.682);出现"逃避症状"与"教育程度"有关(OR=0.112,p<0.05,CI=0.016～0.796);出现"过度警觉症状"与"回避应对行为"(OR=7.341,p<0.05,CI=1.607～33.535)、"屈服应对行为"(OR=6.681,p<0.05,CI=1.589～28.086)有关。结论 "屈服应对行为"可预测PTSD的发病;"烧伤面积"是出现"闪回症状"的危险因素;"教育程度"是出现"逃避症状"的保护因素;"回避应对行为"、"屈服应对行为"是出现"过度警觉症状"的危险因素。

Objective To explore the status and impact factors of severe bum patients accompanying post - traumatic stress disorder （PTSD）. Methods 64 cases of severe bum inhospital patients were ramdomly chosen. And their demographic data, burn situations and data of assessments of medical coping styles questionnaire （MCMQ） and post - traumatic stress disorder symptoms list - civilian version （ PCL - C） were colocted. In order to investigating their coping behavior modes, symptoms of PTSD and the core syndmms of ＂flash back＂ ,＂ avoidance＂, ＂hypervigi- lance＂. Consider the demographic data, bums situations and evaluation index data of MCMQ as the independent vari- ables, and the evaluation index data of PCL - C as dependent variables, established Logistic regression models in or- der to testify the causality between two kinds of variables. Results More severe bum patients are inclined to use ＂a- voidance＂ or ＂resignation＂ behavior than normal people（t were 7.06,7. 76,p 〈0.01 ）. 46. 9% of participants suf- fered from PTSI）. PTSD symptoms were related to Resighnation coping behavior（ OR were 10. 150, 9. 333 ;p 〈0. 01 ; CI were 2. 149 47. 936, 1. 637,53.208 ）. Flash - back syndromes were related to Total bum surface area （ OR = 4. 234, p 〈 0. 01, CI = 1. 535 - 11. 682）. Avoidance syndromes were related to educational status （ OR = 0. 112 ,p 〈 O. 05, CI = 0. 016 -0. 796）. Hypervigillance syndromes were related to avoidance coping behavior（ OR = 7. 341 ,p 〈 0. 05, CI = 1. 607 - 33. 535 ）, and resignation coping behavior（ OR = 6. 681, P 〈 0.05, CI = 1. 589 - 28.086）. Con- clusion Resighnation coping behavior could predict PTSD symptoms. Total bum surface area was risk factor to flash -back syndromes. Educational status was protective factor to avoidance syndromes. ＂Avoidance＂ and ＂resignation＂ behavior were risk factors to hypervigillance syndromes.