本文選題：車禍傷 + 心理應(yīng)激　； 參考：《第三軍醫(yī)大學(xué)》2008年碩士論文

【摘要】： 目的:隨著社會的進步,經(jīng)濟的發(fā)達(dá),人們在各項活動中使用交通工具已越來越頻繁,交通事故導(dǎo)致的急性創(chuàng)傷也逐漸成為威脅人們健康及生命安全的主要危險之一。據(jù)WHO預(yù)測,至2020年交通傷每年的死亡與致殘人數(shù)將增加60%以上,在全球疾病負(fù)擔(dān)排序中交通傷上升到第3位;道路交通事故已成為中國男性和城市居民的意外傷害致死的第一位原因,也成為發(fā)達(dá)國家的第一位公共衛(wèi)生問題〔1、2〕。 車禍?zhǔn)录且环N嚴(yán)重的突發(fā)的應(yīng)激性生活事件,可導(dǎo)致受傷者產(chǎn)生強烈的心理和軀體雙重應(yīng)激反應(yīng)〔3〕。這種應(yīng)激反應(yīng)給受傷者在機體上造成不同程度生理損傷的同時,也會使機體在創(chuàng)傷應(yīng)激源的作用下出現(xiàn)一系列的生理、心理和行為的變化,使機體處于程度不同的心理應(yīng)激狀態(tài)。車禍傷由于其突發(fā)性和傷情復(fù)雜、對比其他疾病而言易導(dǎo)致患者強烈的心理應(yīng)激與個體心理健康水平下降,較非車禍致傷患者出現(xiàn)更多的情緒反應(yīng)〔1〕,如焦慮、抑郁、激怒等,對預(yù)后產(chǎn)生明顯的影響。車禍傷后患者對這種非同尋常的威脅或災(zāi)難事件所引發(fā)的精神壓力不能正確釋放或正確認(rèn)知時就可能導(dǎo)致創(chuàng)傷后應(yīng)激障礙〔4〕。有研究表明,焦慮的程度與創(chuàng)傷后應(yīng)激障礙的發(fā)生有較高的相關(guān)性〔5〕;創(chuàng)傷后應(yīng)激障礙中焦慮與抑郁為兩種經(jīng)常伴隨的情緒障礙,是最常見的與免疫異常有聯(lián)系的心理狀態(tài),可導(dǎo)致抗體生成下降、淋巴細(xì)胞增值反應(yīng)受到抑制、自然殺傷細(xì)胞活性下降等〔6〕;這些改變可反過來加重原有創(chuàng)傷或疾病的病理改變,影響治療效果及預(yù)后。 創(chuàng)傷后心理應(yīng)激障礙、焦慮與抑郁情緒由于人的生理、心理、社會因素等多層次屬性(如心理素質(zhì)、個性特征、個人處境、應(yīng)對方式等)的不同而呈現(xiàn)不同的狀態(tài),這些狀態(tài)關(guān)系到生物體對環(huán)境的適應(yīng)和機體內(nèi)穩(wěn)態(tài)的保持,與疾病的發(fā)生、發(fā)展、轉(zhuǎn)歸均有著十分密切的關(guān)系。 近年來學(xué)者對創(chuàng)傷后心理應(yīng)激影響因素的研究已逐漸在深入。有文獻表明,其交通事故后患者的創(chuàng)傷嚴(yán)重程度與早期的精神痛苦嚴(yán)重程度等是創(chuàng)傷后心理應(yīng)激障礙患病的主要影響因素,在經(jīng)歷潛在創(chuàng)傷性事件后約有25%的患者發(fā)生傷后心理應(yīng)激障礙,其發(fā)生率與創(chuàng)傷事件的性質(zhì)與嚴(yán)重程度有關(guān)。但這些研究在患者傷情嚴(yán)重程度的判斷上鮮見采用具體的、量化的ISS(創(chuàng)傷嚴(yán)重度評分)系統(tǒng)來調(diào)查SCL-90(心理癥狀自評量表)〔7〕、SAS(焦慮自評量表)〔7〕、SDS(抑郁自評量表)〔8〕在車禍致傷患者中的變化,從而探討車禍傷患者的受傷部位、創(chuàng)傷的嚴(yán)重程度與患者的心理健康狀況的關(guān)系以及相關(guān)的影響因素(如性別、年齡、既往身體健康狀態(tài)、社會支持程度、經(jīng)濟來源、文化程度等)鮮見報道,且更是值得探討的問題。 方法:入組納入標(biāo)準(zhǔn):1、選擇2007.9-2008.4期間入住西南醫(yī)院急救創(chuàng)傷病房因車禍致傷、意識清楚、配合檢查、配合問卷調(diào)查的住院車禍致傷患者,年齡與性別不限。利用自制傷員個人信息表、ISS創(chuàng)傷嚴(yán)重度評分及SCL-90量表、SAS、SDS量表進行創(chuàng)傷嚴(yán)重程度與心理健康狀況和相關(guān)影響因素調(diào)查;2、排除標(biāo)準(zhǔn):意識不清或不配合檢查及問卷調(diào)查者。3、調(diào)查方式:采用SCL-90癥狀自評量表、SAS、SDS量表問卷式調(diào)查,并通過體格檢查、醫(yī)學(xué)儀器輔助檢查進行創(chuàng)傷嚴(yán)重度評分(ISS),傷者自行填寫個人信息表。常模采用汪向東“心理衛(wèi)生評定量表手冊”、張明園“精神科評定量表手冊”中常模數(shù)據(jù)。4、共完成有效問卷入組的傷員200例,其中男性患者164例,女性患者36例,年齡13-79歲;其中受傷部位以顱腦傷為主66例(33%),四肢骨折傷為主97例(48%),胸腹部傷為主26例(13%),脊柱傷及毀損傷為主11例(6%)。ISS16分有173例(86%),16≤ISS≤25分有27例(13%),ISS25分有1例(1%)。將結(jié)果利用SPSS13.0軟件包進行統(tǒng)計分析。 結(jié)果:入組的200例車禍傷患者SCL-90總均分及各因子得分、SAS、SDS得分高于常模,有顯著統(tǒng)計學(xué)差異(P0.01)。其中SCL-90各因子、SAS、SDS得分增高與患者的性別、既往身體健康狀態(tài)、社會交往支持程度和創(chuàng)傷嚴(yán)重程度有顯著的相性關(guān)(p0.05～0.01)。車禍傷患者的受傷部位、年齡、文化程度、經(jīng)濟來源與SCL-90各因子、焦慮和抑郁情緒的產(chǎn)生無明顯的相關(guān)性。 結(jié)論:車禍傷患者在遭受突然的車禍打擊后有較高的心理應(yīng)激反應(yīng),這種心理應(yīng)激反應(yīng)與傷者的性別、既往身體健康狀況、社會支持程度和創(chuàng)傷嚴(yán)重度有明顯的相關(guān)性;提示車禍傷患者傷后心理應(yīng)激反應(yīng)較高,其心理健康狀況不容樂觀,在重視車禍傷患者的急救與治療同時切不可忽略傷者的心理狀態(tài)。 由于車禍傷來勢兇猛、傷情復(fù)雜,人們更多是關(guān)注威脅生命的傷情和努力減少死亡與傷殘,而對急救、治療、手術(shù)及康復(fù)中對傷者極其重要的心理健康狀況往往關(guān)注不足。 車禍?zhǔn)峭蝗话l(fā)生的、難以承受的或是災(zāi)難性的,對生命構(gòu)成嚴(yán)重的威脅,這是導(dǎo)致傷者產(chǎn)生精神障礙的直接原因,對患者的身心打擊非常直接而重大,往往會產(chǎn)生強烈的心理應(yīng)激反應(yīng),影響治療效果及預(yù)后。從WHO提倡的健康概念看,現(xiàn)代醫(yī)學(xué)的目標(biāo)就是最大可能的使人們不僅在生理軀體上健康,更重要的是要心理健康和有良好的社會適應(yīng)能力。因此,重視和早期發(fā)現(xiàn)車禍傷患者不良或過度的的心理應(yīng)激反應(yīng)、分析其原因、找出其影響因素,并針對性的給予干預(yù),使其能夠有良好的身心康復(fù)狀態(tài)、增強其社會適應(yīng)能力是創(chuàng)傷急救臨床中不可忽略的重要措施。
[Abstract]:Objective : With the progress of society and the development of economy , the use of vehicles in various activities has become more and more frequent , and the acute trauma caused by traffic accidents has become one of the major risks that threaten people ' s health and life safety . According to the WHO forecast , the annual death and disability of traffic accidents will increase by more than 60 % in 2020 , and traffic injuries increase to level 3 in the ranking of global disease burden . Road traffic accidents have become the first cause of accidental injury to male and urban residents in China and become the first public health problem in developed countries &bra; 1 , 2 &ket; .


There are a series of physiological , psychological and behavioral changes which can lead to a decrease in psychological stress and mental health in patients with traumatic stress .


Post - traumatic psychological stress disorder , anxiety and depression mood are different from multi - level attributes such as psychological quality , personality characteristics , personal situation , coping style , etc . , which relate to the adaptation of the organism to the environment and the maintenance of homeostasis in the organism , and have very close relationship with the occurrence , development and transformation of the disease .


In recent years , the study of the influential factors of post - traumatic psychological stress has gradually been in - depth . The literature shows that the severity of trauma and the severity of psychological stress disorder after trauma are the main influencing factors of psychological stress disorder after trauma . However , the study shows that the severity of trauma is related to the severity of traumatic event . However , these studies rarely reported the relationship between the severity of trauma and the psychological health of the patient and the related factors ( such as sex , age , previous health status , social support degree , economic source and culture degree ) .


Methods : A total of 200 patients with trauma severity and mental health status and related factors were investigated by using self - made personal information table , ISS trauma severity score and SCL - 90 scale , SAS and SDS scales .


Results : The scores of SCL - 90 and SAS and SDS scores were significantly higher in 200 cases of accident injury than those in normal mode ( P0.01 ) . Among them , the scores of SCL - 90 , SAS and SDS were significantly different from those of the patients . There was no significant correlation between the scores of injury , age , culture , economic origin and SCL - 90 , anxiety and depression .


Conclusion : The psychological stress response is significantly correlated with the sex of the injured person , the former physical health condition , the degree of social support and the severity of trauma . The mental health condition of the injured patient is not optimistic , and the psychological state of the injured person can not be neglected .


Due to the ferocity of the accident and the complexity of the injury , people are more concerned about the injury of life and the efforts to reduce the death and disability , while the psychological health status of the wounded in first aid , treatment , operation and rehabilitation is often insufficient .


The aim of modern medicine is to bring people not only to physical and physical health , but also to have good social adaptability .
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2008
【分類號】：R64;R395

【參考文獻】

相關(guān)期刊論文 前10條

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本文編號：2084688