儿童气质特征和反复呼吸道感染的相关研究
摘要
目的生物—心理—社会医学模式已得到了普遍认同,心理因素在疾病的发生、发展过程中起着不可忽视的作用。现代心理学一般认为,气质主要是生物学决定的相当稳定而持久的心理特征。每个儿童都有自己不同的气质,通过气质测评可以了解儿童的个性心理特征。近几年来,人们对气质进行了广泛的研究,主要集中在儿童气质特征与行为问题及影响因素等的相关分析上。由于在临床上重视不多,很少与疾病的诊断和治疗相结合。小儿反复呼吸道感染是儿童在临床上的常见病。其病因复杂,往往是多种因素的共同作用引起的。为此,我们从儿童的心理角度着手,做了儿童气质特征与反复呼吸道感染的相关性研究,来探讨不同儿童气质类型发生反复呼吸道感染比例的差异,找出气质对引起反复呼吸道感染的相关因素的影响。为更人性化治疗反复呼吸道感染提供参考依据。
方法随机选取大连市某幼儿园4-5岁儿童进行问卷调查,留取112份有效问卷进行研究。气质分析采用《NYLS 3-7岁儿童气质问卷》[1] ,事先向家长解释填写方法及注意事项,由和儿童一起生活的知情家长填写。气质类型的划分依据儿童各气质纬度的得分高低,划出三种气质类型,即易养型、中间型和难养型。反复呼吸道感染的儿童诊断亦采用问卷形式,根据儿童近几年每年患上呼吸道感染和下呼吸道感染的次数,依据全国小儿呼吸道疾病学术会议上提出的儿童反复呼吸道感染诊断标准进行诊断[2]。将该样本儿童分为反复呼吸道感染组和非反复呼吸道感染组。
结果1、由气质划分的易养型、中间型、难养型三种类型儿童在活动水平、趋避性、适应度、反应强度、情绪本质、坚持度、注意力分散度、反应阈上存在显著差异(P<0.05)。2、与其他两种类型儿童相比难养型儿童患反复呼吸道感染比例高,差异有显著性(X2=6.743,P=0.034)。3、反复呼吸道感染的儿童中难养型数量较多。4、气质的9个维度因子对反复呼吸道感染影响的多因素Logistic回归分析提示:反应强度是反复呼吸道感染的危险因子。
结论1、难养型气质儿童患反复呼吸道感染的几率较其他类型儿童高。2、气质维度中的反应强度是让儿童暴露于引起反复呼吸道感染的相关因素的危险因子。3、对反复呼吸道感染儿童的气质进行分析,有助于了解其心理特征,为诊断、干预、治疗提供依据。
Objective: Biopsychosocial medical model has been identified generally. Psychological factors have important effects on occurring and developing of the diseases. Contemporary psychology believes generally that temperament is stable, durable mental characteristic determined by biology. Every child has his special temperament. We can learn the children’s personal characteristic of mentality by the temperament test. Recently, people have studied the temperament widely. The study is mainly focus on the analysis of the relation between the character of temperament and behavior or the factors that affect the temperament. Because being paid great attention to a little, it is combined with the diagnosis and treatment of diseases fewer. Repeatedly respiratory infection of children is common disease in clinic. The causes of RRI are complicated which are composed by many factors. Therefore we study the relationship of children’s temperament characteristic and RRI from mental point of view as well as analyzing the different ratio among the different children who suffer from RRI, to find the influence that the temperament affect the factors which cause RRI. A reference basis can be provided for humanistic treatment of RRI .
Methods: 112 questionnaires were chosen to be studied from some 4-5 years old preschool children’s in Dalian. Temperament questionnaires were used respectively for children aged 3-7 years old. In advance, we explained the instructions and attentions to the parents who have lived with their children when filled in these forms. According to the scores of different dimensionality, easy temperament, intermediate temperament and difficult temperament are classified. Questionnaires were also used todiagnose RRI. Children who suffers from upper respiratory tract diseases and lower respiratory tract diseases every year are diagnosed RRI according to the diagnostic standard brought up in Children Respiratory Tract Disease Academic Conference .Then these children are divided into RRI group and not RRI group.
Result : 1. The easy temperament, intermediate temperament and difficult temperament groups classified by temperament showed a great difference in their activity level, approach withdrawal, adaptability, intensity of reaction, mood, persistence , distraction and threshold of reaction (p<0.05). 2. The proportion of difficulty type that were made a diagnosis of RRI is higher than others and shows a great difference (x2=6.743,p=0.034). 3. The numbers of difficult are the most in children of RRI. 4. Logistic Regression analysis showed that the intensity of reaction had effect on RRI .
Conclusion : 1. Children of difficult type suffered from RRI are more than other types. 2. The intensity of reaction is a dangerous factor which makes children to be exposed to elements that cause RRI. 3. It is useful for children’s characteristic of mentality to analyse the temperament of the children suffered from RRI, hereby to provide a reference basis for diagnosis, interference and treatment .
方法随机选取大连市某幼儿园4-5岁儿童进行问卷调查,留取112份有效问卷进行研究。气质分析采用《NYLS 3-7岁儿童气质问卷》[1] ,事先向家长解释填写方法及注意事项,由和儿童一起生活的知情家长填写。气质类型的划分依据儿童各气质纬度的得分高低,划出三种气质类型,即易养型、中间型和难养型。反复呼吸道感染的儿童诊断亦采用问卷形式,根据儿童近几年每年患上呼吸道感染和下呼吸道感染的次数,依据全国小儿呼吸道疾病学术会议上提出的儿童反复呼吸道感染诊断标准进行诊断[2]。将该样本儿童分为反复呼吸道感染组和非反复呼吸道感染组。
结果1、由气质划分的易养型、中间型、难养型三种类型儿童在活动水平、趋避性、适应度、反应强度、情绪本质、坚持度、注意力分散度、反应阈上存在显著差异(P<0.05)。2、与其他两种类型儿童相比难养型儿童患反复呼吸道感染比例高,差异有显著性(X2=6.743,P=0.034)。3、反复呼吸道感染的儿童中难养型数量较多。4、气质的9个维度因子对反复呼吸道感染影响的多因素Logistic回归分析提示:反应强度是反复呼吸道感染的危险因子。
结论1、难养型气质儿童患反复呼吸道感染的几率较其他类型儿童高。2、气质维度中的反应强度是让儿童暴露于引起反复呼吸道感染的相关因素的危险因子。3、对反复呼吸道感染儿童的气质进行分析,有助于了解其心理特征,为诊断、干预、治疗提供依据。
Objective: Biopsychosocial medical model has been identified generally. Psychological factors have important effects on occurring and developing of the diseases. Contemporary psychology believes generally that temperament is stable, durable mental characteristic determined by biology. Every child has his special temperament. We can learn the children’s personal characteristic of mentality by the temperament test. Recently, people have studied the temperament widely. The study is mainly focus on the analysis of the relation between the character of temperament and behavior or the factors that affect the temperament. Because being paid great attention to a little, it is combined with the diagnosis and treatment of diseases fewer. Repeatedly respiratory infection of children is common disease in clinic. The causes of RRI are complicated which are composed by many factors. Therefore we study the relationship of children’s temperament characteristic and RRI from mental point of view as well as analyzing the different ratio among the different children who suffer from RRI, to find the influence that the temperament affect the factors which cause RRI. A reference basis can be provided for humanistic treatment of RRI .
Methods: 112 questionnaires were chosen to be studied from some 4-5 years old preschool children’s in Dalian. Temperament questionnaires were used respectively for children aged 3-7 years old. In advance, we explained the instructions and attentions to the parents who have lived with their children when filled in these forms. According to the scores of different dimensionality, easy temperament, intermediate temperament and difficult temperament are classified. Questionnaires were also used todiagnose RRI. Children who suffers from upper respiratory tract diseases and lower respiratory tract diseases every year are diagnosed RRI according to the diagnostic standard brought up in Children Respiratory Tract Disease Academic Conference .Then these children are divided into RRI group and not RRI group.
Result : 1. The easy temperament, intermediate temperament and difficult temperament groups classified by temperament showed a great difference in their activity level, approach withdrawal, adaptability, intensity of reaction, mood, persistence , distraction and threshold of reaction (p<0.05). 2. The proportion of difficulty type that were made a diagnosis of RRI is higher than others and shows a great difference (x2=6.743,p=0.034). 3. The numbers of difficult are the most in children of RRI. 4. Logistic Regression analysis showed that the intensity of reaction had effect on RRI .
Conclusion : 1. Children of difficult type suffered from RRI are more than other types. 2. The intensity of reaction is a dangerous factor which makes children to be exposed to elements that cause RRI. 3. It is useful for children’s characteristic of mentality to analyse the temperament of the children suffered from RRI, hereby to provide a reference basis for diagnosis, interference and treatment .
引文
1. 张劲松,王玉凤. NYLS《3-7 岁儿童气质量表》测试报告. 中国心理卫生杂志, 1995,9 (5):203.
2. 沈叙庄,陈惠中. 第 23 届国际儿科大会有关呼吸系统疾病交流内容简介 [J]. 中国实用儿科杂志, 2002,17(2):120-121.
3. 林江涛 ,何权瀛 . 下呼吸道感染防治中的几个问题 [J]. 中国实用内科杂志, 1998, 18 (5):305-306.
4. Chess S . Studies in temperament :A paradigm in psychosocial research .Yale – Biol –Med .1990.63(4):313..
5. Drummond PD Hewson Bower B. Increased psychosocial stress and decreased mucosal immunity in children with recurrent respiratory tract infections [J] . J Psychosom Res.1997.43(3):271-278.
6. Hewson-Bower B. Drummond PD . Psychological treatment for recurrent symp- toms of colds and flu in children [J] . J Psychosom Res. 2001,51(1):369-377.
7. 李侠,赵新 . 3-7 岁儿童进食行为与气质关系的探讨 [ J] .中国心理卫生杂志2001,1:49-51.
8. 张 梓 荆 . 小 儿 反 复 呼 吸 道 感 染 治 疗 近 况 [J] . 中 国 中 西 医 结 合 杂 志 , 1996,16(9):571-574.
9. 常克萍. 反复呼吸道感染研究进展 [J] . 临床儿科杂志 , 2001,19(5):316-317.
10. 冯学斌,黄薇等. 反复呼吸道感染患儿血清 IgG 亚类缺陷与微量元素缺乏相互关系的探讨 [J] . 中国实用儿科杂志, 1995,10(4):211-213.
11. 李敏.345 例反复呼吸道感染小儿血清微量元素含量的测定 [J] .广西医科大学学报,1998,15(1):78-79.
12. 刘运广,杨贵彬,林娜等. 反复呼吸道感染儿血清β-胡萝卜素、维生素 A、E 含量与免疫功能的关系 [J] . 实用儿科临床杂志, 1999,14(1):7-8.
13. 李侠,王洪 . 3-7 岁麻烦型气质儿童餐桌行为的心理干预 . 中国心理卫生杂志, 2003,4:25-27.
14. 黄文瑞 . 多种微量元素佐治小儿反复呼吸道感染的疗效及免疫学观察 [J]. 中国当代儿科杂志, 2000,2(3):172-173.
15. 旷寿金,肖水源 . 抚育因素对儿童反复呼吸道感染的影响 [J]. 中国当代儿科杂志, 2000,2(4):272-273.
16. 张涌静,张金梅. 父母教育方式与儿童气质关系的研究 . 中国临床心理学杂志, 2002,10(2):145-147.
1. 姚凯南. 儿童气质测量及其临床应用. 国外医学妇幼保健分册 2002,13(6): 249-251.
2. 耀华 .气质的测量和鉴定.山西老年, 1999,5:36-37.
3. 时乐. 中医学与现代心理学气质学说之比较. 辽宁中医学院学报,2002,4:14-15.
4. LARKE-STEWART KA.FITZPATRICK MJ, ALL-HUSEN VD .et al,Measuring difficult temperament the easy way [ J] .J Dev Behav Pediatr,2000,21:207-220.
5. 曾爱华,王桂菊.儿童气质研究进展.中国儿童保健杂志,2006,14(2):177-179.
6. Ebstein RP,Auerhach J. Dopamine D4 receptor, serotonin transporter genotypes and temperament in early childhood [J ]. Biol Psychiatry,2000,47:10.
7. ARBELLE S,BENJAMIN J,GOLIN M,et al.Relation of shyness in grade school children to the genotype for the long form of the serotonin transporter promoter region polymor-phism [J].Am J Psychiatry. 2003.160:671-676.
8. AUERBACH JG.FAROY M,EBSTEIN R.et al.The association of the dopamine D4 receptor gene ( DRD4) and the serotonin transporter promoter gene( 5-HT TLPR) with temperament in 12-month-old infants [J]. J Child Psychol Psychiatry ,2001,42 :777-783.
9. LAKATOS K, NEMODA Z, BIRKAS E.et al. Association of D4 dopamine receptor gene and serotonin transporter promoter polymorphisms with infants’ response to novelty [J] .Mol Psychiatry,2003,8:90-97.
10. 赵冬梅.3-7 岁儿童气质的影响因素研究.中国生育健康杂志, 2001,12(3): 116-119.
11. 姚凯南 . 发育行为儿童.西安:陕西科学技术出版社, 1999,28.
12. 夏梓红,文秋生. 1-6 岁儿童气质特征探讨. 中国妇幼保健 , 2004,19:79-80.
13. 黄红,张劲松 . 气质特点与婴幼儿相关性的初步探讨 . 中国儿童保健杂志, 2002,10(2):83-85.
14. 刘玉芬,刘贵媛. 幼儿气质的早期干预.健康心理学杂志, 2001,9( 1):23-27.
15. 钟云莺 家庭环境因素对学龄前儿童气质影响的研究 . 江西医学院学报,2006,46(5):137-139,141.
16. 黄燕虹,林昆.学龄前儿童气质与家庭环境因素的相关研究. 国际医药卫生导报,2006,12(24):8-11.
17. 王桂香 .学龄前儿童气质与行为问题的关系探讨 .中国儿童保健杂志 .2006, 2(14):48-50.
18. 翁小平,冯玲英,李惠蓉等. 儿童学习成绩与智力、气质、家庭环境的相关研究 [J]. 中国儿童保健杂志 ,2000,8(5):292-293.
19. 傅荣佳,宋黎.单纯肥胖儿童气质特点及相关因素研究.中国儿童保健杂志, 2005,3:193-196
20. 杨少萍,吴汉荣等. 武汉市学龄前儿童睡眠障碍与气质关系的研究 . 中国学校卫生,2006, 9:9-10.
21. NIKLASR. Perceived difficulty temperament, hostile maternal child-rearing attitudes and insulin resistance syndrome prccurors among children a 3-year follow-up study[J]. Psychother Psychosom.2001,70:66-77.
22. 何惠,孙淑英. 儿科医生需要了解的有关气质问题.中国儿童保健杂志 1997,3:61,74.
23. 林茂英,洪新如 . 慢性疾病住院患儿气质与父母素质的关系及其干预措施 . 解放军护理杂志, 2003,20(1):5-7.
2. 沈叙庄,陈惠中. 第 23 届国际儿科大会有关呼吸系统疾病交流内容简介 [J]. 中国实用儿科杂志, 2002,17(2):120-121.
3. 林江涛 ,何权瀛 . 下呼吸道感染防治中的几个问题 [J]. 中国实用内科杂志, 1998, 18 (5):305-306.
4. Chess S . Studies in temperament :A paradigm in psychosocial research .Yale – Biol –Med .1990.63(4):313..
5. Drummond PD Hewson Bower B. Increased psychosocial stress and decreased mucosal immunity in children with recurrent respiratory tract infections [J] . J Psychosom Res.1997.43(3):271-278.
6. Hewson-Bower B. Drummond PD . Psychological treatment for recurrent symp- toms of colds and flu in children [J] . J Psychosom Res. 2001,51(1):369-377.
7. 李侠,赵新 . 3-7 岁儿童进食行为与气质关系的探讨 [ J] .中国心理卫生杂志2001,1:49-51.
8. 张 梓 荆 . 小 儿 反 复 呼 吸 道 感 染 治 疗 近 况 [J] . 中 国 中 西 医 结 合 杂 志 , 1996,16(9):571-574.
9. 常克萍. 反复呼吸道感染研究进展 [J] . 临床儿科杂志 , 2001,19(5):316-317.
10. 冯学斌,黄薇等. 反复呼吸道感染患儿血清 IgG 亚类缺陷与微量元素缺乏相互关系的探讨 [J] . 中国实用儿科杂志, 1995,10(4):211-213.
11. 李敏.345 例反复呼吸道感染小儿血清微量元素含量的测定 [J] .广西医科大学学报,1998,15(1):78-79.
12. 刘运广,杨贵彬,林娜等. 反复呼吸道感染儿血清β-胡萝卜素、维生素 A、E 含量与免疫功能的关系 [J] . 实用儿科临床杂志, 1999,14(1):7-8.
13. 李侠,王洪 . 3-7 岁麻烦型气质儿童餐桌行为的心理干预 . 中国心理卫生杂志, 2003,4:25-27.
14. 黄文瑞 . 多种微量元素佐治小儿反复呼吸道感染的疗效及免疫学观察 [J]. 中国当代儿科杂志, 2000,2(3):172-173.
15. 旷寿金,肖水源 . 抚育因素对儿童反复呼吸道感染的影响 [J]. 中国当代儿科杂志, 2000,2(4):272-273.
16. 张涌静,张金梅. 父母教育方式与儿童气质关系的研究 . 中国临床心理学杂志, 2002,10(2):145-147.
1. 姚凯南. 儿童气质测量及其临床应用. 国外医学妇幼保健分册 2002,13(6): 249-251.
2. 耀华 .气质的测量和鉴定.山西老年, 1999,5:36-37.
3. 时乐. 中医学与现代心理学气质学说之比较. 辽宁中医学院学报,2002,4:14-15.
4. LARKE-STEWART KA.FITZPATRICK MJ, ALL-HUSEN VD .et al,Measuring difficult temperament the easy way [ J] .J Dev Behav Pediatr,2000,21:207-220.
5. 曾爱华,王桂菊.儿童气质研究进展.中国儿童保健杂志,2006,14(2):177-179.
6. Ebstein RP,Auerhach J. Dopamine D4 receptor, serotonin transporter genotypes and temperament in early childhood [J ]. Biol Psychiatry,2000,47:10.
7. ARBELLE S,BENJAMIN J,GOLIN M,et al.Relation of shyness in grade school children to the genotype for the long form of the serotonin transporter promoter region polymor-phism [J].Am J Psychiatry. 2003.160:671-676.
8. AUERBACH JG.FAROY M,EBSTEIN R.et al.The association of the dopamine D4 receptor gene ( DRD4) and the serotonin transporter promoter gene( 5-HT TLPR) with temperament in 12-month-old infants [J]. J Child Psychol Psychiatry ,2001,42 :777-783.
9. LAKATOS K, NEMODA Z, BIRKAS E.et al. Association of D4 dopamine receptor gene and serotonin transporter promoter polymorphisms with infants’ response to novelty [J] .Mol Psychiatry,2003,8:90-97.
10. 赵冬梅.3-7 岁儿童气质的影响因素研究.中国生育健康杂志, 2001,12(3): 116-119.
11. 姚凯南 . 发育行为儿童.西安:陕西科学技术出版社, 1999,28.
12. 夏梓红,文秋生. 1-6 岁儿童气质特征探讨. 中国妇幼保健 , 2004,19:79-80.
13. 黄红,张劲松 . 气质特点与婴幼儿相关性的初步探讨 . 中国儿童保健杂志, 2002,10(2):83-85.
14. 刘玉芬,刘贵媛. 幼儿气质的早期干预.健康心理学杂志, 2001,9( 1):23-27.
15. 钟云莺 家庭环境因素对学龄前儿童气质影响的研究 . 江西医学院学报,2006,46(5):137-139,141.
16. 黄燕虹,林昆.学龄前儿童气质与家庭环境因素的相关研究. 国际医药卫生导报,2006,12(24):8-11.
17. 王桂香 .学龄前儿童气质与行为问题的关系探讨 .中国儿童保健杂志 .2006, 2(14):48-50.
18. 翁小平,冯玲英,李惠蓉等. 儿童学习成绩与智力、气质、家庭环境的相关研究 [J]. 中国儿童保健杂志 ,2000,8(5):292-293.
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