医疗事故鉴定患者创伤后应激障碍的症状及相关因素分析

Symptoms and Analysis of Correlation Factors of Patients with Post-traumatic Stress Disorder in Malpractice Evaluation

目的探讨委托医疗事故鉴定患者创伤后应激障碍(posttraumatic stress disorder,PTSD)症状及相关因素。方法采用创伤后应激障碍清单(PCL-C)、状态-特质焦虑问卷(state-trait anxiety inventory,STAI)、抑郁自评量表(self-rating depression scale,SDS)、艾森克个性问卷(eysenck personality questionnaire,EPQ)对委托医疗事故鉴定154例PTSD的发生率及症状相关性进行评价。结果本研究收回有效问卷151份,以50分作为分界值,PTSD发生率为21.19%(32/151,PTSD组)。鉴定为事故组的PTSD发生率高于无事故组及终止鉴定组(P<0.05),事故组闯入性症状、高警觉性及PCL-C总分均高于其他两组(P<0.05)。PTSD组闯入性症状、高警觉性、回避症状及PCL-C总分均高于非PTSD组(P<0.05);患者中女性较男性有更多的闯入性再体验症状及高警觉性,男性患者更多表现为回避症状(P<0.05)。回归分析显示,焦虑、抑郁状态及神经质是PTSD发生的重要预知因素。结论委托医疗事故鉴定患者PTSD的发生率高,症状明显,对其心理影响大;抑郁、焦虑状态、神经质是PTSD发生的危险因素,需及时干预。

Objective To explore the patients＇ symptoms and correlation factors of posttraumatic stress disorder（ PTSD） in appraisable malpractice. Methods The incidence rate of PTSD and symptom correlation of 154 patients in appraisable malpractice were evaluated with PTSD Check list-Civilian Version（ PCL-C）,State-Trait Anxiety Inventor（ STAI）questionnaire,Self-Rating Depression Scale（ SDS） and Eysenck Personality Questionnaire（ EPQ）. Results In this study,151 valid questionnaires were retrieved,and the incidence rate of PTSD was 21. 19%（ 32 /151 in PtSD group） with a score of50 as the boundary value. The incidence rate of PTSD in identified malpractice group was higher compared with those in non malpractice group and termination identification group（ P 〈0. 05）. The intruded symptom,high alertness and total PCL-C scores in malpractice group were significantly higher than those in the other two groups（ P 〈0. 05）. The intruded symptoms,high alertness,approach-avoidance symptom and total PCL-C scores in PTSD group were significantly higher than those in non PTSD group（ P 〈0. 05）; incidence rates of intruded symptom and high alertness in females were significantly higher than those in males,but the incidence rate of approach-avoidance symptom in males was significantly higher than in females（ P 〈0. 05）.Regression analysis result showed that anxiety state,depression and neuroticism were important predictors of PTSD. Conclusion The incidence rate of PTSD in appraisable malpractice patients is high with obvious symptoms and mental problems for patients. The anxiety state,depression and neuroticism are the risk factors of PTSD. So intervention for PTSD is necessary.