汶川地震救援军人创伤后应激障碍两年随访及影响因素分析

目的跟踪研究“5·12”汶川地震救援军人创伤后应激障碍（PrSD）的发生率及病程转归，分析PTSD相关危险因素。方法采用流行病学调查初筛与精神科临床确诊相结合的方法，于震后半年随机整群抽样1024名军人，使用自编救援经历量表（REQ）、急性应激状况调查表（SRQ-20）及PTSD筛查量表（PCL—C）进行初筛，由精神科医师依据DSM一1V轴I障碍用临床定式检查（SCID—I）对初筛结果高于划界分者进行一对一晤谈确定诊断，并对其中470名军人连续随访2年。结果6个月时点确诊PTSD患者35例，患病率为3．42％，其中56．25％在24个月仍未痊愈；24个月时点随访，PTSD患病率为2．13％，其中90％为6个月时已确诊PTSD患者；以是否患PTSD为因变量，进行多重Logistic回归分析，进入方程变量为急性应激障碍（ASD），现场搜救、处理遗体等重任务，PCL—C总分，SDS总分，救援经历和任务对自己心理的影响等7个因素。结论“5·12”抗震救援军事人员PTSD患病率较平时阴sD患病率显著增高，病程迁延且自然缓解率低，应当在充分关注同时加强心理干预与对症治疗。本研究还探讨了PTSD相关危险因素，为今后构建军人心理应激损伤防护策略提供了科学依据。

Prevalence and impact factors of PTSD in Chinese military rescuers after Wenchuan earthquake:A two-year follow-up study

Objective To investigate the prevalence and related impact factors of post-traumatic stress disorder（PTSD） among military rescuers 6 months after ＂5 ~ 12＂ Wenchuan earthquake. Methods All the 1024 military rescuers were as- sessed by the rescue experience questionaire （REQ）, self-report questionaire-20 （SRQ-20） and PTSI） checklist-civilian ver- sion （PCL-C） as preliminary screening. Clinical interviews were used to make a definite diagnosis by psychiatrists according to structured clinical interview I for DSM-1V （SCID- I ）. A total of 470 rescuers were surveyed over a two-year follow-up period. Results The prevalence of FI＇SD was 3.42% at 6 months and 2.13% at 24 months after the earthquake. A total of 9 （56.23%） of the original 16 PTSD subjects were identified as FI＇SD at the two-year post-earthquake follow-up. Logis- tic regression analysis showed that ASD, rescue missons, PCL-C score, SDS score and effect on one＇s psychology et al were the impact factors of PTSD. Conclusion The prevalence of FFSD among the rescuers is significantly increased than in nor- mal situations. The course of disease is relatively long and the remission rate is relatively low. The result of the present study shows significant predictors of PTSD, contributing to psychological protection and crisis intervention.