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  本文選題：法醫(yī)臨床學　切入點：司法精神病學　出處：《昆明醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：[目的]顱腦外傷對人體危害較大,是造成神經(jīng)系統(tǒng)功能障礙的常見原因,日常生活能力、社會活動能力喪失程度是顱腦外傷后進行精神傷殘等級評定的主要依據(jù)。本研究初步探討并細化傷殘評定標準中日常生活或社會功能受損的評定標準,既可為司法鑒定中精神傷殘等級評定提供依據(jù),也可為精神傷殘等級條款制定分級細則提供參考。[方法]①收集昆明醫(yī)科大學司法鑒定中心和云南省紅十字會醫(yī)院2014-2016年進行精神傷殘評定的案例198例,根據(jù)被鑒定人入院臨床診斷顱腦損傷類型和鑒定時提供的CT片,結(jié)合神經(jīng)系統(tǒng)檢查及精神檢查,定性被鑒定人顱腦外傷后所致功能障礙的嚴重程度;②綜合運用法醫(yī)精神病鑒定、日常生活活動能力評估量表:改良Barthel指數(shù)評定量表(MBI)和日常生活自理能力評定量表(ATCO),社會功能受損評估量表:社會功能缺陷篩選量表(SDSS)和功能活動調(diào)查表(FAQ),評估顱腦損傷患者神經(jīng)系統(tǒng)功能障礙的嚴重程度與精神傷殘等級之間的關(guān)系。[結(jié)果]①顱腦損傷所致精神傷殘者,精神傷殘嚴重程度與SDSS量表、FAQ量表、MBI量表、ATCO量表評分結(jié)果的嚴重程度、顱腦損傷恢復(fù)情況之間均具有統(tǒng)計學意義(P0.05);②單因素logistics回歸分析中以社會功能缺陷篩選量表(SDSS)、功能活動調(diào)查表(FAQ)評定的社會功能受損和以改良Barthel指數(shù)評定量表(MBI)、日常生活自理能力量表(ATCO)評定的日常生活能力受損與精神傷殘嚴重程度具有顯著相關(guān)性(P0.05);③與精神傷殘嚴重程度具有相關(guān)性的自變量進行有序多分類logistics回歸分析,得出社會功能缺陷篩選量表(SDSS)評定的社會功能受損和改良Barthel指數(shù)評定量表(MBI)評定的日常生活活動能力受損為精神傷殘嚴重程度的危險因素(P0.05);④不同精神傷殘程度間SDSS量表、FAQ量表、MBI量表、ATCO量表平均分差異均具有統(tǒng)計學意義(P0.05),并且SDSS量表、FAQ量表、MBI量表、ATCO量表均對精神傷殘嚴重程度具有良好的區(qū)分;⑤不同精神傷殘等級間量表評定比較得出SDSS量表適合于十級、九級、八級、七級傷殘之間的評定,FAQ量表適合于十級、九級、八級、七級傷殘等級之間的評定,MBI量表適用于四級、五級、六級、七級、八級傷殘等級之間的評定,ATCO量表適用于六級、七級、八級傷殘等級之間的評定。[結(jié)論]①精神傷殘等級評定時,先采用標準化評定量表對精神傷殘嚴重程度進行分度,然后再分級,更有利于精神傷殘等級的區(qū)分;②SDSS量表、FAQ量表、MBI量表、ATCO量表適用的精神傷殘等級的范圍不完全相同,存在一定交叉;③建議在進行傷殘等級評定時,十級傷殘和九級傷殘可以采用SDSS量表和FAQ量表進行區(qū)分,八級傷殘和七級傷殘可以綜合采用MBI量表、ATCO量表、SDSS量表和FAQ量表進行區(qū)分,而六級以上精神傷殘不適合采用量表區(qū)分。
[Abstract]:[objective] craniocerebral trauma is a common cause of nervous system dysfunction, which is harmful to human body. The degree of loss of social activity is the main basis for the assessment of mental disability after craniocerebral trauma. It can provide the basis for the evaluation of mental disability grade in judicial expertise. It can also provide a reference for the establishment of classification rules for the terms of mental disability grade. [methods] 1 198 cases of mental disability assessment were collected from Kunming Medical University Forensic Identification Center and Yunnan Red Cross Hospital from 2014-2016. According to the type of clinical diagnosis of craniocerebral injury and the CT film provided during the appraisal, combined with the examination of nervous system and mental examination, the degree of dysfunction caused by brain injury in the identified person was determined by the comprehensive use of forensic psychiatric examination. Activity of Daily living (ADL) scale: modified Barthel Index rating scale (Barthel) and ADL Self-Care Assessment scale (ADL), Social function impairment scale (SDSS) and functional activities questionnaire (ADL) were evaluated. The relationship between the severity of nervous system dysfunction and the degree of mental disability in patients with craniocerebral injury. [results] 1Mental disability caused by craniocerebral injury, The severity of mental disability and the severity of the scores of SDSS and SDSS. The recovery of craniocerebral injury was statistically significant. In the single factor logistics regression analysis, the social function impairment was assessed by the Social function impairment screening scale (SDSS) and the modified Barthel Index was used to evaluate the social function. There was a significant correlation between the impairment of daily living ability and the severity of mental disability. The independent variables with correlation with the severity of mental disability were analyzed by logistics regression analysis. It is concluded that the impairment of social function assessed by the Social function screening scale (SDSS) and the impairment of daily living ability assessed by the modified Barthel Index scale are the risk factors for the severity of mental disability. There were significant differences in the average scores of the SDSS scale and the SDSS scale, and the SDSS scale and the MBI scale and the ATCO scale had a good distinction in terms of the severity of mental disability. (5) there was a good distinction between the mental disability rating scale and the different mental disability rating scale (MBI scale), and there was a good distinction between the SDSS scale and the MBI scale for the severity of mental disability. Compared with each other, the SDSS scale is suitable for ten grades. Rating between Grade 9, Grade 8 and Grade 7 the FAQ scale is suitable for rating between grade 10, Grade 9, Grade 8 and Grade 7. The MBI scale is suitable for 4, 5, 6, and 7 levels. The ATCO scale can be used to evaluate the mental disability severity between grade 6, grade 7 and grade 8. [conclusion] 1 the standardized rating scale is used to grade the severity of mental disability. Then the classification is more advantageous to the differentiation of mental disability grade. The range of mental disability grade applied to MBI scale and ATCO scale is not exactly the same as that of MBI scale and ATCO scale. It is suggested that there is a certain degree of crossover in the assessment of disability grade. SDSS scale and FAQ scale can be used to distinguish the 10 and 9 degree disability, MBI scale / MBI scale and FAQ scale can be used to distinguish the 8 and 7 levels of disability, but the mental disability above grade 6 is not suitable to be distinguished by the scale.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：D919.4

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