烧伤%教育程度%体表面积%焦虑%抑郁%应激障碍,创伤后%应对行为
燒傷%教育程度%體錶麵積%焦慮%抑鬱%應激障礙,創傷後%應對行為
소상%교육정도%체표면적%초필%억욱%응격장애,창상후%응대행위
Burns%Educational status%Body surface area%Anxiety%Depression%Stress disorders,post-traumatic%Coping behavior
目的 探讨重度烧伤患者教育程度、烧伤面积及应对行为对其并发心理障碍的影响方法 采取整群随机抽样法,选取暨南大学医学院第四附属医院(广州市红十字会医院)、广东省工伤康复中心及广东省人民医院收治的64例重度烧伤患者,统计其人口学、烧伤情况等资料,并采用医学应对问卷、焦虑自评量表(SAS)、抑郁自评量表(SDS)、创伤后应激障碍(PTSD)检查量表-平民版(PCL-C)调查患者疾病应对方式和并发焦虑、抑郁、PTSD及其3个核心症状闪回、逃避、过度警觉的情况.对人口学资料、烧伤情况及应对行为与患者并发心理障碍情况进行相关分析,对教育程度、烧伤面积及应对行为与患者并发心理障碍情况进行预测分析.对数据行t检验；将定性自变量赋值,行Spearman等级相关分析、多元线性回归分析. 结果 (1)64例重度烧伤患者面对应对得分为(19.0±3.4)分,与国内常模的(19.5±3.8)分比较,差异无统计学意义(t=-1.13,P＞0.05)；回避、屈服应对得分分别为(16.6±2.4)、(11.0±2.2)分,显著高于国内常模的(14.4±3.0)、(8.8±3.2)分(t值分别为7.06、7.76,P值均小于0.01).患者SAS、SDS、PCL-C标准分依次为(50±11)、(54±11)、(38±12)分,有89.1％ (57/64)、60.9％ (39/64)、46.9％(30/64)的患者存在焦虑、抑郁、PTSD症状.(2)本组患者年龄、性别、婚姻状况、伤后时间等4个自变量与其并发心理障碍有相关性,但无统计学意义(rs值为-0.089～0.245,P值均大于0.05).教育程度与焦虑、抑郁、PTSD、闪回、逃避均呈显著负相关(rs值为-0.361 ～-0.253,P值均小于0.05)；与过度警觉呈负相关,但无统计学意义(rs=-0.187,P＞0.05).烧伤面积与患者并发心理障碍均呈显著正相关(rs值为0.306 ～0.478,P值均小于0.05).面对应对行为与患者并发心理障碍均呈正相关,但无统计学意义(rs值为0.121～0.550,P值均大于0.05)；回避应对行为与患者并发心理障碍均有相关性,但无统计学意义(rs值为-0.144～0.193,P值均大于0.05)；屈服应对行为与患者并发心理障碍均呈显著正相关(r.值为0.377～0.596,P值均小于0.01).(3)教育程度对患者罹患焦虑、PTSD及其闪回症状有预测力(t值为-2.19 ～-2.02,P值均小于0.05),但对其罹患抑郁及PTSD的逃避、过度警觉症状无预测力(t值为-1.95～-0.99,P值均大于0.05).烧伤面积对患者罹患心理障碍均无预测力(t值为0.55 ～1.78,P值均大于0.05).应对行为中屈服应对行为对患者罹患心理障碍均有预测力(t值为3.10～6.46,P值均小于0.01),面对及回避应对行为对患者罹患心理障碍均无预测力(t值分别为0.46 ～2.32、-0.89 ～1.75,P值均大于0.05). 结论 教育程度越低、烧伤面积越大、越趋向于采取屈服应对行为的患者越易罹患焦虑、抑郁和PTSD等心理障碍.
目的 探討重度燒傷患者教育程度、燒傷麵積及應對行為對其併髮心理障礙的影響方法 採取整群隨機抽樣法,選取暨南大學醫學院第四附屬醫院(廣州市紅十字會醫院)、廣東省工傷康複中心及廣東省人民醫院收治的64例重度燒傷患者,統計其人口學、燒傷情況等資料,併採用醫學應對問捲、焦慮自評量錶(SAS)、抑鬱自評量錶(SDS)、創傷後應激障礙(PTSD)檢查量錶-平民版(PCL-C)調查患者疾病應對方式和併髮焦慮、抑鬱、PTSD及其3箇覈心癥狀閃迴、逃避、過度警覺的情況.對人口學資料、燒傷情況及應對行為與患者併髮心理障礙情況進行相關分析,對教育程度、燒傷麵積及應對行為與患者併髮心理障礙情況進行預測分析.對數據行t檢驗；將定性自變量賦值,行Spearman等級相關分析、多元線性迴歸分析. 結果 (1)64例重度燒傷患者麵對應對得分為(19.0±3.4)分,與國內常模的(19.5±3.8)分比較,差異無統計學意義(t=-1.13,P＞0.05)；迴避、屈服應對得分分彆為(16.6±2.4)、(11.0±2.2)分,顯著高于國內常模的(14.4±3.0)、(8.8±3.2)分(t值分彆為7.06、7.76,P值均小于0.01).患者SAS、SDS、PCL-C標準分依次為(50±11)、(54±11)、(38±12)分,有89.1％ (57/64)、60.9％ (39/64)、46.9％(30/64)的患者存在焦慮、抑鬱、PTSD癥狀.(2)本組患者年齡、性彆、婚姻狀況、傷後時間等4箇自變量與其併髮心理障礙有相關性,但無統計學意義(rs值為-0.089～0.245,P值均大于0.05).教育程度與焦慮、抑鬱、PTSD、閃迴、逃避均呈顯著負相關(rs值為-0.361 ～-0.253,P值均小于0.05)；與過度警覺呈負相關,但無統計學意義(rs=-0.187,P＞0.05).燒傷麵積與患者併髮心理障礙均呈顯著正相關(rs值為0.306 ～0.478,P值均小于0.05).麵對應對行為與患者併髮心理障礙均呈正相關,但無統計學意義(rs值為0.121～0.550,P值均大于0.05)；迴避應對行為與患者併髮心理障礙均有相關性,但無統計學意義(rs值為-0.144～0.193,P值均大于0.05)；屈服應對行為與患者併髮心理障礙均呈顯著正相關(r.值為0.377～0.596,P值均小于0.01).(3)教育程度對患者罹患焦慮、PTSD及其閃迴癥狀有預測力(t值為-2.19 ～-2.02,P值均小于0.05),但對其罹患抑鬱及PTSD的逃避、過度警覺癥狀無預測力(t值為-1.95～-0.99,P值均大于0.05).燒傷麵積對患者罹患心理障礙均無預測力(t值為0.55 ～1.78,P值均大于0.05).應對行為中屈服應對行為對患者罹患心理障礙均有預測力(t值為3.10～6.46,P值均小于0.01),麵對及迴避應對行為對患者罹患心理障礙均無預測力(t值分彆為0.46 ～2.32、-0.89 ～1.75,P值均大于0.05). 結論 教育程度越低、燒傷麵積越大、越趨嚮于採取屈服應對行為的患者越易罹患焦慮、抑鬱和PTSD等心理障礙.
목적 탐토중도소상환자교육정도、소상면적급응대행위대기병발심리장애적영향방법 채취정군수궤추양법,선취기남대학의학원제사부속의원(엄주시홍십자회의원)、광동성공상강복중심급광동성인민의원수치적64례중도소상환자,통계기인구학、소상정황등자료,병채용의학응대문권、초필자평량표(SAS)、억욱자평량표(SDS)、창상후응격장애(PTSD)검사량표-평민판(PCL-C)조사환자질병응대방식화병발초필、억욱、PTSD급기3개핵심증상섬회、도피、과도경각적정황.대인구학자료、소상정황급응대행위여환자병발심리장애정황진행상관분석,대교육정도、소상면적급응대행위여환자병발심리장애정황진행예측분석.대수거행t검험；장정성자변량부치,행Spearman등급상관분석、다원선성회귀분석. 결과 (1)64례중도소상환자면대응대득분위(19.0±3.4)분,여국내상모적(19.5±3.8)분비교,차이무통계학의의(t=-1.13,P＞0.05)；회피、굴복응대득분분별위(16.6±2.4)、(11.0±2.2)분,현저고우국내상모적(14.4±3.0)、(8.8±3.2)분(t치분별위7.06、7.76,P치균소우0.01).환자SAS、SDS、PCL-C표준분의차위(50±11)、(54±11)、(38±12)분,유89.1％ (57/64)、60.9％ (39/64)、46.9％(30/64)적환자존재초필、억욱、PTSD증상.(2)본조환자년령、성별、혼인상황、상후시간등4개자변량여기병발심리장애유상관성,단무통계학의의(rs치위-0.089～0.245,P치균대우0.05).교육정도여초필、억욱、PTSD、섬회、도피균정현저부상관(rs치위-0.361 ～-0.253,P치균소우0.05)；여과도경각정부상관,단무통계학의의(rs=-0.187,P＞0.05).소상면적여환자병발심리장애균정현저정상관(rs치위0.306 ～0.478,P치균소우0.05).면대응대행위여환자병발심리장애균정정상관,단무통계학의의(rs치위0.121～0.550,P치균대우0.05)；회피응대행위여환자병발심리장애균유상관성,단무통계학의의(rs치위-0.144～0.193,P치균대우0.05)；굴복응대행위여환자병발심리장애균정현저정상관(r.치위0.377～0.596,P치균소우0.01).(3)교육정도대환자리환초필、PTSD급기섬회증상유예측력(t치위-2.19 ～-2.02,P치균소우0.05),단대기리환억욱급PTSD적도피、과도경각증상무예측력(t치위-1.95～-0.99,P치균대우0.05).소상면적대환자리환심리장애균무예측력(t치위0.55 ～1.78,P치균대우0.05).응대행위중굴복응대행위대환자리환심리장애균유예측력(t치위3.10～6.46,P치균소우0.01),면대급회피응대행위대환자리환심리장애균무예측력(t치분별위0.46 ～2.32、-0.89 ～1.75,P치균대우0.05). 결론 교육정도월저、소상면적월대、월추향우채취굴복응대행위적환자월역리환초필、억욱화PTSD등심리장애.
Objective To discuss how the educational status,burn area and coping behaviors influence the psychological disorders in severely burned patients.Methods Sixty-four severely burned patients hospitalized in Guangzhou Red Cross Hospital,Guangdong Provincial Work Injury Rehabilitation Center,and Guangdong General Hospital were enrolled with cluster random sampling method.Data of their demography and situation of burns were collected.Then their coping behavior,psychological disorders including anxiety,depression and post-traumatic stress disorder (PTSD) plus its core symptoms of flashback,avoidance,and hypervigilance were assessed by medical coping modes questionnaire,self-rating anxiety scale (SAS),self-rating depression scale (SDS),PTSD checklist-civilian version (PCL-C) respectively.Correlation was analyzed between demography,burn area,coping behavior and psychological disorders.The predictive powers of educational status,burn area and coping behaviors on the psychological disorders were analyzed.The qualitative variables were assigned values.Data were processed with t test,Spearman rank correlation analysis,and multiple linear regression analysis.Results (1) The patients scored (19.0 ± 3.4) points in confrontation coping behavior,which showed no statistically significant difference from the domestic norm score (19.5 ±3.8) points (t =-1.13,P ＞0.05).The patients scored (16.6 ±2.4) and (11.0 ±2.2) points in avoidance and resignation coping behaviors,which were significantly higher than the domestic norm score (14.4 ± 3.0),(8.8 ± 3.2) points (with t values respectively 7.06 and 7.76,P values both below 0.01).The patients' standard score of SAS,SDS,PCL-C were (50 ± 11),(54 ± 11),and (38 ± 12)points.Respectively 89.1％ (57/64),60.9％ (39/64),46.9％ (30/64) of the patients showed anxiety,depression,and PTSD symptoms.(2) Four independent variables:age,gender,marital status,and time after burns,were correlated with the psychological disorders,but the correlativity was not statistically significant (with rs values from-0.089 to 0.245,P values all above 0.05).Educational status was significantly negatively correlated with anxiety,depression,PTSD and its core symptoms of flashback,avoidance (with rs values from-0.361 to-0.253,P values all below 0.05).Educational status was negatively correlated with hypervigilance,but the correlativity was not statistically significant (rs =-0.187,P ＞0.05).Burn area was significantly positively correlated with the psychological disorders (with rs values from 0.306 to 0.478,P values all below 0.05).Confrontation coping behavior was positively correlated with the psychological disorders,but the correlativity was not statistically significant (with rs values from 0.121 to 0.550,P values all above 0.05).Avoidance coping behavior was correlated with the psychological disorders,but the correlativity was not statistically significant (with rs values from-0.144 to 0.193,P values all above 0.05).Resignation coping behavior was significantly positively correlated with the psychological disorder (with rs values from 0.377 to 0.596,P values all below 0.01).(3) Educational status had predictive power on the anxiety,PTSD and flash back symptoms of patients (with t values from-2.19 to-2.02,P values all below 0.05),but not on depression,avoidance and hypervigilance (with t values from-1.95 to -0.99,P values all above 0.05).Burn area had no predictive power on the psychological disorders (with t values from 0.55 to 1.78,P values all above 0.05).Resignation coping behavior had predictive power on the psychological disorders (with t values from 3.10 to 6.46,P values below 0.01).Confrontation and avoidance coping behaviors had no predictive power on the psychological disorders (with t values from 0.46 to 2.32 and-0.89 and 1.75 respectively,P values all above 0.05).Conclusions The severely burned patients with lower educational status,larger burn area,and the more frequently adapted resignation coping behavior are more likely to suffer from anxiety,depression,and PTSD.
