急性手外伤患者心理状态、社会因素与手功能恢复相关性的初步研究

The relationship of psychological status and social factors with hand function recovery in patients with hand injury： a preliminary study

目的调查急性手外伤患者心理疾病的发生率并探讨心理状态、社会因素与手功能恢复的相关性。方法随访231例急性手外伤患者，调查记录其一般社会资料及受伤时状态，通过创伤后心理应激障碍症状访谈量表（posttraumatic stress disorder symptom scale—interview，PSS-I）、贝克抑郁自评量表（Beck depression inventory，BDI）、焦虑自评量表（self-rating anxiety scale，SAS）、社会支持评定量表、改良手损伤程度评分表（modified hand injury severity scoring system，MHISS）以及上肢功能评分表（disability of arm，shoulder and hand，DASH）评估患者术后（平均15个月）的心理状态、社会支持度和手功能，利用SPSS17．0软件研究三者间相关性。结果231例患者中创伤后心理应激障碍（posttraumatic stress disorder，PTSD）发生率为40．7％，焦虑发生率为22．9％，抑郁发生率为39．8％；手功能恢复与焦虑（P=0．025）、抑郁（P〈0．001）、PTSD（P=0．002）和损伤程度（P=0．040）密切相关，疼痛与焦虑（P=0．007）、抑郁（P=0．005）、PTSD（P=0．004）、社会支持（P=0．043）和损伤程度（P=0．036）密切相关；医疗费用支付方式不同，PTSD（P=0．046）和疼痛（P=0．043）情况显著不同。结论手外伤患者心理疾病的发生率高于普通人群，手功能恢复和疼痛与心理因素和社会支持密切相关，社会因素中医疗费用的支付方式与PTSD和疼痛密切相关。

Objective To investigate the incidence of psychological diseases in patients with occupational hand injury and the correlation of psychological status and social factors with hand function recovery. Methods A total of 231 patients with occupational hand injuries were involved in this study. Sociodemographic characteristics of the patients and severity of the injury were collected. Modified hand injury severity scoring system （MHISS） was used to document severity of the injury. Psychological status was assessed using the posttraumatic stress disorder symptom scale-interview （PSS- I ）, the Beck depression inventory （BDI） and the self-rating anxiety scale （SAS）. Social support was assessed using Social Support Questionnaire. Hand function was assessed using Disability of Arm, Shoulder and Hand （DASH）. The SPSS 17.0 was used to analyze the correlation of the factors. Results Of the 231 patients, the incidence of posttraumatic stress disorder （PTSD） was 40.7%, anxiety was 22.9% and depression was 39.8%. Hand function was closely negatively correlated with anxiety （ P = 0. 025）, depression （ P 〈 0. 001 ）, PTSD （ P = 0. 002） and severity of hand injury （P = 0.040）. Pain was closely correlated with anxiety （ P = 0.007）, depression （ P = 0.005）, PTSD （ P = 0.004）, social support （ P = 0.043） and severity of hand injury （ P = 0.036）. The situation of PTSD （ P = 0. 046） and pain （ P = 0.043） was significantly different among patients with different payment options for hospitalization cost. Conclusion The incidence of psychological problems was significantly higher in patients with acute hand injuries. The psychological status and social support were closely correlated with hand function recovery and pain. The payment option for hospitalization cost was the most significant social factor that affected PTSD and pain.