九寨沟地震伤员急性应激期睡眠状况及应对策略的研究

A study on the sleep state of trauma patients in Jiuzhaigou earthquake during the acute stress period and their countermeasures

目的深入了解九寨沟地震伤员灾后急性期的睡眠状况、睡眠障碍的真实体验及应对策略。方法采用阿森斯失眠量表（AIS）评估地震灾后36例伤员的睡眠情况，并应用质性研究的现象学研究方法，对存在睡眠障碍的16例伤员进行半结构式访谈，分析伤员的睡眠真实体验及应对策略。结果不同婚姻状况、年龄、受教育程度、民族、亲人是否遇难、是否截肢（残疾）伤员睡眠障碍发生情况差异均有统计学意义（P〈0．05）。质性研究提炼出3个主题：灾后伤员睡眠障碍类型多样化；睡眠障碍引起疲乏和消极情绪；应对策略单一或缺乏。结论离异或丧偶、50岁以上、受教育程度低、亲人遇难、截肢或残疾的地震伤员发生睡眠障碍比率更高，是心理危机干预的重点人群。建议采取团体咨询和个体化康复方案协同、建立专家一家庭一社会三级协助机制、多种心理治疗方法与药物干预结合、完善心理救援机制等策略，改善地震伤员的睡眠质量，促进地震伤员的身心健康。

Objective To deeply explore the sleep state, real experience of sleep disorders and countermeasures in trauma patients in Jiuzhaigou earthquake during the acute stress period after the disaster. Methods The Athens Insomnia Scale （AIS） was used to evaluate the sleep state of totally 32 trauma patients in earthquake. Their real experience of sleep as well as countermeasures were analyzed through the semi-structural interview for 16 patients who showed sleep disorders using the phenomenological method in the qualitative study. Results The incidence of sleep disorders among these trauma patients were attributed to their marital status, age, educational level, nationality, whether they had families who were dead in the disaster and whether they were amputated （paralyzed） （P〈0.05）. The results boiled clown to three topics ： the sleep disorders in these patients were diverse; sleep disorders contributed to fatigue and negative emotions; and their countermeasures were onefold or lacking. Conclusions The trauma patients who are divorced or widowed, aged 50 or above, with a lower educational level, whose families are dead in the earthquake, or who are amputated or paralyzed are more likely to show sleep disorders, so they should be the focus of psychological crisis intervention. It is advised to improve the sleep quality and physical and mental health of trauma patients by such strategies as synergizing group counseling and individualized rehabilitation programs, building a three-level assistance mechanism involving experts, families and the society, combining multiple psyehotherapies and medicine intervention and improving the psychological salvation mechanism.