青少年创伤性骨折后急性应激障碍的影响因素分析
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摘要
目的探讨青少年创伤性骨折后急性应激障碍(acute stress disorder,ASD)的影响因素。方法对本院2011年3月至2018年3月收治的300例创伤性骨折青少年患者进行研究,采用斯坦福急性应激反应问卷(Stanford acute stress reaction questio nnaire,SASRQ)、社会支持评定量表(social support rating scale,SSRS)、视觉模拟评分法(visual analogue scales,VAS)、简易应对方式问卷(simplified coping style questionnaire,SCSQ)以及艾森克人格问卷简式量表中国版(Eysenck perso nality questi onnaire-revised short scale for Chinese,EPQ-RSC)对所有患者进行问卷调查,统计患者ASD发生情况,并分析相关影响因素。38例患者符合ASD诊断,纳入A组,其余262例患者纳入B组。结果女性、住院天数<7 d、损伤严重程度评分(injury severity score,ISS)≥16分患者更易发生ASD;两组患者SSRS总分、客观支持、L量表及P量表评分比较均无显著差异(P_均> 0.05),A组患者VAS、消极应对、N量表评分均显著高于B组(P_均<0.05),主观支持、积极应对、对社会支持的利用度及E量表评分均显著低于B组(P_均<0.05)。SASRQ总分与P量表、VAS评分均呈正相关(r=0.437、0.518),与主观支持、积极应对、E量表均呈负相关(r=-0.647、-0.408、-0.339)。结论对于创伤严重、性格内向、情绪不稳定、主诉疼痛感强的创伤性骨折青少年患者应及时干预,以减少ASD的发生。
Objective To explore the influencing factors of acute stress disorder(ASD) in adolescents with traumatic fractures. Method A total of 300 young patients with traumatic fractures treated in our hospital from March 2011 to March 2018 were studied used the Stanford acute stress reaction questionnaire(SASRQ) and social support rating scale(SSRS), visual analogue scales(VAS), simplified coping style questionnaire(SCSQ), and the Eysenck personality questionnaire-revised short scale for Chinese(EPQ-RSC). A questionnaire survey was conducted on all patients to calculate the incidence of ASD in patients and analyze relevant influencing factors. 38 patients were diagnosed with ASD and included in group A, and the remaining 262 patients were included in group B. According to statistics. Result Women, hospitalization days < 7 d, injury severity score(ISS) ≥ 16 points were more likely to occur ASD. There were no significant differences in SSRS total score, objective support, L scale and P scale score between the two groups(P_(all)> 0.05). The VAS, negative coping, and N scale scores of group A patients were significantly higher than those of group B(P_(all)< 0.05); and subjective support, positive response, use of social support, and E scale scores were significantly lower than group B(P_(all)< 0.05). The total score of SASRQ was positively correlated with P scale and VAS score(r = 0.437, 0.518), and negatively correlated with subjective support, positive response, and E scale(r =-0.647,-0.408,-0.339). Conclusion Traumatic fractures adolescents with severe trauma, introversion, emotional instability, and complaints of pain should be promptly intervened to reduce the occurrence of stress disorder.
Objective To explore the influencing factors of acute stress disorder(ASD) in adolescents with traumatic fractures. Method A total of 300 young patients with traumatic fractures treated in our hospital from March 2011 to March 2018 were studied used the Stanford acute stress reaction questionnaire(SASRQ) and social support rating scale(SSRS), visual analogue scales(VAS), simplified coping style questionnaire(SCSQ), and the Eysenck personality questionnaire-revised short scale for Chinese(EPQ-RSC). A questionnaire survey was conducted on all patients to calculate the incidence of ASD in patients and analyze relevant influencing factors. 38 patients were diagnosed with ASD and included in group A, and the remaining 262 patients were included in group B. According to statistics. Result Women, hospitalization days < 7 d, injury severity score(ISS) ≥ 16 points were more likely to occur ASD. There were no significant differences in SSRS total score, objective support, L scale and P scale score between the two groups(P_(all)> 0.05). The VAS, negative coping, and N scale scores of group A patients were significantly higher than those of group B(P_(all)< 0.05); and subjective support, positive response, use of social support, and E scale scores were significantly lower than group B(P_(all)< 0.05). The total score of SASRQ was positively correlated with P scale and VAS score(r = 0.437, 0.518), and negatively correlated with subjective support, positive response, and E scale(r =-0.647,-0.408,-0.339). Conclusion Traumatic fractures adolescents with severe trauma, introversion, emotional instability, and complaints of pain should be promptly intervened to reduce the occurrence of stress disorder.
引文
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[18]马琴,周华,邱菲,等.疼痛控制护理对创伤性骨折患者疼痛程度心理状态及康复质量的影响[J].山西医药杂志,2017,46(5):608-610.
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[2]姚志洪.医学模式和健康服务[J].自然杂志,2015,37(5):362-368.
[3]刘秀华,徐菲菲,崔红,等.汶川地震救援人员创伤后应激障碍状况调查[J].转化医学杂志,2015,4(2):69-73.
[4]杨淑娟.车祸创伤致失血性休克的急救护理体会[J].转化医学电子杂志,2016,3(4):88-88.
[5]Li WHC,Chung JOK,Ho KY,et al.Play interventions to reduce anxiety and negative emotions in hospitalized children[J].BMC Pediatr,2016,16:36.
[6]Jiang C,Rau PP.The detrimental effect of acute stress on response inhibition when exposed to acute stress:an eventrelated potential analysis[J].Neuroreport,2017,28(14):922-928.
[7]赵建,丁日高.重大化学灾害事件医学应急救援预案的准备[J].国际药学研究杂志,2016,43(1):110-113.
[8]杜建政,夏冰丽.急性应激障碍(ASD)研究述评[J].心理科学进展,2009,17(3):482-488.
[9]Carde?a E,Koopman C,Classen C,et al.Psychometric prope rties of the Stanford Acute Stress Reaction Questionnaire(SASRQ):a valid and reliable measure of acute stress[J].J Trauma Stress,2000,13(4):719-734.
[10]Northcott S,Moss B,Harrison K,et al.A systematic review of the impact of stroke on social support and social networks:asso ciated factors and patterns of change[J].Clin Rehabil,2016,30(8):811-831.
[11]周文华,孙红,刘继海,等.视觉模拟评分法评估急诊科拥挤度研究[J].中华急诊医学杂志,2015,24(5):512-516.
[12]王端卫,张敬悬.简易应对方式问卷的因子分析[J].山东大学学报(医学版),2014,52(3):96-100.
[13]钱铭怡,武国城,朱荣春,等.艾森克人格问卷简式量表中国版(EPQ-RSC)的修订[J].心理学报,2000,32(3):317-323.
[14]赵威,黄杨,王玉同,等.损伤严重程度评分对重度创伤病情评估的意义与预后相关性研究[J].临床误诊误治,2014,27(1):7-10.
[15]汪璐璐,刘安诺,李惠萍,等.创伤后成长与创伤后应激障碍症状相关性的meta分析[J].中国心理卫生杂志,2016,30(1):23-28.
[16]Jones JM,Williams WH,Jetten J,et al.The role of psych ol ogicalsymptoms and social group memberships in the development of post-traumatic stress after traumatic injury[J].Br JHealth Psychol,2012,17(4):798-811.
[17]魏有红,夏翠兰,周运彩,等.手外伤致残患者心理状态调查及护理干预[J].中华全科医学,2013,11(9):1426-1427.
[18]马琴,周华,邱菲,等.疼痛控制护理对创伤性骨折患者疼痛程度心理状态及康复质量的影响[J].山西医药杂志,2017,46(5):608-610.
[19]陈琼妮,刘莉,张丹,等.社会支持对精神分裂症患者生活质量和康复的影响[J].中国临床心理学杂志,2016,24(1):185-187.
[20]黄景玉,贾艳滨,钟舒明,等.抑郁症患者人格特征与认知功能的相关性[J].广东医学,2016,37(17):2584-2587.