重型颅脑损伤患者精神障碍的临床分析

目的：探讨重型颅脑损伤后精神障碍的影响因素，发生率，临床特征。方法：以江苏省扬州市1998年9月24日至2000年12月26日因交通事故所致理型颅脑损伤的161例幸存为研究对象，在颅脑损伤后（平均7．6个月），3名精神科副主任医师根据中国精神疾病分类方案与诊断标准第二版修订本对这些伤的精神状态进行评估。结果：（1）在161例中，患各类精神障碍共141例，发生率为87．58％，其中智能障碍为128例（79．5％）。（2）在161例中，中度及其以上智力损伤为26例（16．15％）。（3）有智力损伤组的脑干损伤、颅内血肿及≥3个脑叶损伤的比例高于无智力损伤组（P＜0．01）；伴有精神病性障碍组的平均年龄（P＜0．05），脑干损伤（P＜0．05）及≥3个脑叶损伤（P＜0．01）的比例高于无精神病性障碍组：有人格改变组额叶损伤、开颅清除血肿并减压治疗的比例高于无人格改变组（P＜0．01）。结论：重型颅脑创伤后精神障碍的发生率较多，智力障碍发生率较多，应引起有关临床学科的重视。

The manifestation of mental disorders in the patients due to severe traumatic brain injury

Objective:To explore the prevalence rates,manifestations and their related factors of mental disorders due to severe traumatic brain injuries Methods: Based on CCMD-2-R,161 Subjects with severe traumatic brain injury who survived from vehicle accidents in yang zhou from Sep 24,1998 to Dec 26,2000 Were assessed by three psychiatrist after 6 months Results: The total incidence of mental disorders in this group was 87 58%(14/161),79 5% of those Subjects Suffered from intellectual impairments,17 4% had neurotic syndromes,8 7% had psychotic syndromes,and 6 8% had secondary personality change Amnestic disorder,depressive or manic syndrome Could be seen in some subjects as well Conclusion: The prevalence rate of mental disorder is high in the patients with severe brain injury It is necessary to give mental intervention to the patients with mental disorders due to traumatic brain injuries