高能量颅脑损伤所致精神障碍的影响因素及早期干预分析

The influencing factors and early intervention of mental disor- ders induced by high-energy craniocerebral injury

目的探讨高能量颅脑损伤所致精神障碍患者的影响因素及早期干预效果。方法对132例高能量颅脑损伤患者进行精神障碍评定，根据评定结果分为对照组和精神障碍组，分析造成精神障碍的影响因素。采用随机数字表法将精神障碍组分为常规组和干预组，均给予常规治疗及护理，干预组在此基础上实施早期干预，观察2个月，于干预后采用蒙特利尔认知评估量表和格拉斯哥昏迷指数量表比较两组精神障碍患者的恢复效果。结果132例患者中检出高能量颅脑损伤所致精神障碍者78例（59．1％），精神障碍组中出现脑于损伤、颅内血肿、昏迷时间≥2d、大范围脑损伤、重度颅脑损伤患者显著多于对照组（P〈0．05或0．01）。干预后常规组与干预组蒙特利尔认知评估量表和格拉斯哥昏迷指数量表评分均较干预前显著升高（P〈O．01），干预组比常规组升高更显著（P〈0．05或0．01）。结论高能量颅脑损伤所致精神障碍的影响因素众多，早期干预能有效提高患者的认知能力，降低颅脑损伤程度，有利于患者病情恢复。

Objective To explore the influencing factors and early intervention of mental disorders induced by high-energy craniocerebral injury （HECI）. Methods Assessments of mental disorders were conducted in 132 HECI patients, they assigned to control and mental disorder group according to assessment results, and factors causing mental disorders analyzed. Mental disorder group were assigned to routine and inter- vention group according to random number table, both group received routine treatment and nursing, in- tervention group was plus early intervention on this basis for 2 months, and recovery results were assessed with Montreal Cognitive Assessment （MCA） and Glasgow Coma Scale （GCS） before and after interven- tion. Results Of 132 HECI patients 78 ones were mental disorders due to HECI （59. 1%）, ones with brain-stem injury, intracranial hematoma, coma time ≥2 days, wide-bound brain injuries or severe cranio- cerebral injury were more in mental disorder than in control group （P〈0.05 or 0.01）. After intervention the MCA and GCS scores of routine and intervention group heightened more significantly compared with pre-intervention （P〈0.01）, so did those in intervention than in control group （P〈0.05 or 0.01）. Conclu- sion The influencing factors of mental disorders due to HECI are more, early intervention could effec tively improve patients＇ congnition, lower craniocerebral injury degree, and is beneficial to patients＂ recov cry.