【摘要】：【背景】腦外傷后認知障礙鑒定案例中，因鑒定結(jié)論與被鑒定人的賠償額度或其他利益等直接相關(guān)，，偽裝或夸大智力傷殘程度的情況是相當(dāng)普遍的。因此,在鑒定時，評估被鑒定人的自述癥狀是否真實可信或者是否存在偽裝，盡量排除故意夸大或偽裝的成分，并以此做出客觀的鑒定結(jié)論，因此，探索并應(yīng)用可靠的偽裝識別技術(shù)至關(guān)重要。 事件相關(guān)電位（event-related potentials, ERP）與認知、感覺等腦電活動相關(guān)，具有高時間精度，較少受被試主觀意愿的影響，且認知事件可與刺激呈現(xiàn)的時間相關(guān)聯(lián)，即鎖時（time-lock）等特點，應(yīng)用于測謊領(lǐng)域的具有獨特優(yōu)勢。研究表明ERP內(nèi)源性成分如P300是檢測偽裝的一個較好指征，利用P300波幅與潛伏期等參數(shù)探查偽裝的腦認知過程和神經(jīng)電生理機制具有可行性。ERP檢測技術(shù)在偽裝認知功能障礙中的探索及應(yīng)用，可為法醫(yī)學(xué)鑒定識別偽裝提供客觀、可行的電生理技術(shù)。 【目的】參考二項必選數(shù)字記憶測驗（BFDMT）的編制原理，根據(jù)偽裝認知損傷者的心理學(xué)特征編制符合實驗要求及ERP技術(shù)規(guī)范的圖形異同判斷刺激序列，比較正常對照組、模擬偽裝組腦外傷合作組和腦外傷不合作組完成刺激序列時誘發(fā)的ERP各特征性成分的差異，并對各特征成分在偽裝檢測中的應(yīng)用價值作出評價。 【方法】根據(jù)二項必選數(shù)字記憶測驗的結(jié)果將20例腦外傷患者分為合作組（男9例，女1例，年齡42.58歲±3.76歲）和不合作組（男8例，女2例，年齡39.77歲±7.34歲），采用Neuroscan ERP儀呈現(xiàn)圖形異同判斷刺激序列并同步記錄腦電，選擇10例正常志愿者（男5例，女5例，年齡25.87歲±1.47歲）作為合作對照組，另選擇15例正常志愿者作為模擬偽裝組（男10例，女5例，年齡24.37±1.35歲），同時檢測二項必選數(shù)字記憶測驗和圖形異同判斷ERP序列，獲得BFDMT總分、容易分、困難分、偏因商數(shù)以及ERP各成分的波幅和潛伏期等觀察指標(biāo)，比較各組受試者的ERP特征性成分及差異。 【結(jié)果】（1）正常對照組的BFDMT總分的均值（24）最高，腦外傷合作組次之（22.9），腦外傷不合作組（15.2），模擬偽裝組（8.93）最低，組間差異比較有極顯著統(tǒng)計學(xué)意義（P0.01）；外傷不合作組（5.2）、模擬偽裝組（3.6）的困難項目分均低于正常對照組（12）和合作組（11.2）（P0.01），模擬偽裝組雖低于外傷不合作組，但無統(tǒng)計學(xué)意義；外傷不合作組（21.8）、模擬偽裝組(19.18)的偏因商數(shù)均高于正常對照組（0）和外傷合作組（0）（P0.01）。（2）圖形異同判斷刺激序列在正常對照組所引出N1、P2、N2、P3、N3波形較為明顯，頭皮分布以Cz、FCz、CPz點的各成分波形最顯著且分化較好；外傷合作組相同圖形引出的N2、P3潛伏期較正常對照組延長（P0.05），無關(guān)圖形引出的P3波幅較正常對照組降低（P0.05），無關(guān)圖形刺激較相同圖形引出的P2、P3、N3潛伏期延長（P0.05），N3波幅升高（P0.05）；（3）外傷不合作組相同圖形引出的P3潛伏期較正常對照組和外傷合作組延長（P0.01）；N3潛伏期較正常對照組延長（P0.05）；外傷不合作組無關(guān)圖形刺激P3潛伏期較正常對照組和外傷合作組延長（P0.01）； N3潛伏期較正常對照組延長（P0.05）；N3波幅較正常對照組和外傷組降低（P0.05）；（4）模擬偽裝組相同圖形引出的P3潛伏期較外傷合作組、外傷不合作組縮短（P0.01），波幅較正常對照組、外傷合作組、外傷不合作組降低（P0.01）；N3潛伏期較正常對照組、外傷合作組、外傷不合作組縮短（P0.01），波幅較正常對照組、外傷合作組、外傷不合作組升高（P0.01）；無關(guān)圖形引出的P3潛伏期較外傷合作組、外傷不合作組縮短（P0.01），波幅較正常對照組、外傷合作組、外傷不合作組降低（P0.01）；N3潛伏期較正常對照組、外傷合作組、外傷不合作組縮短（P0.01），波幅較正常對照組、外傷合作組、外傷不合作組升高（P0.01）；（5）正常對照組N3成分的腦電地形圖在相同、無關(guān)兩類刺激下主要激活部位為前額葉、頂葉，而外傷合作組伴有部分枕葉激活，外傷不合作組枕葉激活范圍較外傷合作組更為廣泛，枕葉激活反圍較正常對照組�。幌嗤瑘D片刺激引起的腦區(qū)激活范圍較無關(guān)刺激大；模擬偽裝組枕葉激活范圍較大，相同刺激下更為明顯。組間比較發(fā)現(xiàn)腦區(qū)激活強度和范圍以正常對照組最大，外傷合作組次之，外傷不合作組最小。 【結(jié)論】本研究采用的圖形異同判斷刺激序列可引出較為穩(wěn)定的ERP成分，圖片刺激呈現(xiàn)后依次引出五個成分波，分別為N1（負向）、P2（正向）、N2（負向）、P3（正向）、N3（負向），其中N3的潛伏期和波幅有組間統(tǒng)計學(xué)意義，在偽裝判斷中可能是一項較為客觀的電生理指標(biāo)。
[Abstract]:[BACKGROUND] It is quite common to disguise or exaggerate the degree of mental disability in cases of post-traumatic cognitive impairment appraisal because the appraisal conclusion is directly related to the amount of compensation or other benefits of the appraised. Intentionally exaggerating or camouflaging components and making objective identification conclusions, therefore, it is essential to explore and apply reliable camouflage identification technology.
Event-related potentials (ERP) are associated with cognitive, sensory and other EEG activities, with high temporal accuracy, less affected by the subjective will of the subjects, and cognitive events can be associated with the time of stimulus presentation, that is, time-lock, which has unique advantages in the field of lie detection. For example, P300 is a good indication for detecting camouflage. It is feasible to explore the brain cognitive process and neuroelectrophysiological mechanism of camouflage by using parameters such as P300 amplitude and latency.
[Objective] According to the principle of binomial compulsory digital memory test (BFDMT), the stimulus sequence was compiled according to the psychological characteristics of the patients with disguised cognitive impairment. The stimulus sequence was judged by the similarities and differences between the two groups according to the experimental requirements and ERP specifications. The difference of each characteristic component of ERP was evaluated, and the application value of each characteristic component in camouflage detection was evaluated.
[Methods] According to the results of binomial compulsory digital memory test, 20 patients with traumatic brain injury were divided into cooperative group (9 males, 1 females, age 42.58 years (+3.76 years) and non-cooperative group (8 males, 2 females, age 39.77 years (+7.34 years). Neuroscan ERP was used to judge the stimulus sequence and record the EEG synchronously. Ten normal volunteers were selected. (5 males, 5 females, age 25.87 years (+1.47 years) as a co-operative control group, and 15 normal volunteers as a simulated camouflage group (10 males, 5 females, age 24.37 (+1.35 years)), while the binomial compulsory digital memory test and graphical similarities and differences to determine ERP sequence, BFDMT total score, easy to score, difficult score, partial factor quotient and ERP components were obtained. Amplitude and latency of the subjects were compared, and the ERP characteristic components of each group were compared.
[Results] The average score of BFDMT was the highest in the normal control group (24), followed by the cooperative group (22.9), the non-cooperative group (15.2) and the simulated camouflage group (8.93). The difference between the two groups was statistically significant (P 0.01); the difficult item scores of the non-cooperative group (5.2) and the simulated camouflage group (3.6) were lower than those of the normal control group (12) and the simulated camouflage group (8.93). In Co-operative Group (11.2) (P 0.01), simulated camouflage group (21.8), simulated camouflage group (19.18) had higher partial factor quotient than normal control group (0) and trauma Co-operative Group (0) (P 0.01). (2) The patterns of N1, P2, N2, P3, N3 were more distinct in the normal control group. Cz, FCz and CPz were the most prominent and well-differentiated components in scalp distribution. The latency of N2 and P3 induced by the same pattern in the traumatic cooperation group was longer than that in the normal control group (P 0.05), the amplitude of P3 induced by unrelated pattern was lower than that in the normal control group (P 0.05), and the latency of P2, P3, N3 induced by unrelated pattern stimulation was longer than that of the same pattern (P 0.05), and the latency of N3 induced by unrelated pattern stimulation was longer (P 0.05 The amplitude increased (P 0.05); (3) The incubation period of P3 in the non-cooperative group was longer than that in the normal control group and the traumatic cooperation group (P 0.01); the incubation period of N3 in the non-cooperative group was longer than that in the normal control group (P 0.05); the incubation period of P3 in the non-cooperative group was longer than that in the traumatic cooperation group (P 0.01); and the incubation period of N3 in the non-cooperative group was longer than that in the normal control group (P The latency of P3 in simulated camouflage group was shorter than that in traumatic cooperation group (P 0.01), the amplitude of P3 was shorter than that in normal control group, traumatic cooperation group and traumatic non-cooperation group (P 0.01), and the latency of N3 was lower than that in normal control group, traumatic cooperation group and traumatic non-cooperation group (P 0.01). The latency of P3 was shorter in the non-cooperative group than that in the traumatic group (P 0.01), the amplitude was shorter (P 0.01), the latency of N3 was shorter (P 0.01), the amplitude was lower (P 0.01), the latency of N3 was lower (P 0.01) and the latency of N3 was shorter (P 0.01). In the non-cooperative group, the amplitude was shorter (P 0.01), the amplitude was higher than that in the normal control group, the cooperative group and the non-cooperative group (P 0.01); (5) In the normal control group, the main activation sites of N3 were prefrontal lobe and parietal lobe under the same stimulation, but the cooperative group was accompanied by partial occipital lobe activation, and the non-cooperative group was accompanied by occipital lobe stimulation. The activation range of the occipital lobe in the simulated camouflage group was larger than that in the traumatic co-operation group, and the activation range of the occipital lobe was smaller than that in the normal control group. In group B, the injury group was the smallest.
[Conclusion] The pattern similarity and dissimilarity judgment stimulus sequence used in this study can lead to more stable ERP components. Five component waves, N1 (negative), P2 (positive), N2 (negative), P3 (positive) and N3 (negative), were drawn in turn after the picture stimulus was presented. The latency and amplitude of N3 were statistically significant, which may be a comparison in camouflage judgment. It is an objective electrophysiological index.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：D919.1

【參考文獻】

相關(guān)期刊論文 前5條

1 趙虎;亢明;;偽裝識別技術(shù)的研究進展[J];法醫(yī)學(xué)雜志;2007年01期

2 高北陵,劉仁剛,唐卓如,陸亞文,胡赤怡,楊彤;顱腦外傷后智力損傷鑒定中裝壞的臨床分析[J];臨床精神醫(yī)學(xué)雜志;2001年03期

3 高北陵;賠償性顱腦外傷患者偽裝智力低下的評估[J];中國臨床心理學(xué)雜志;2001年03期

4 高北陵,劉仁剛,李映平,盛璐;必選數(shù)字記憶測驗對偽裝記憶損傷的鑒別作用[J];中國臨床心理學(xué)雜志;2001年04期

5 高北陵 ,丁樹明 ,劉仁剛 ,李映平 ,盛璐 ,李志宏 ,陳建良;偽裝與非偽裝腦外傷患者數(shù)字再認測驗結(jié)果分析[J];中國心理衛(wèi)生雜志;2003年01期

本文編號：2232512