特大爆炸事故幸存者创伤后应激障碍的研究

背景创伤后应激障碍(posttraumatic stress disorder,PTSD)是指由异乎寻常的威胁性或灾难性心理创伤,导致延迟出现和长期持续的精神障碍.有关各类自然灾害引起的PTSD的报道较多见,而因技术性灾难事故引起的PTSD的报道不多.特大爆炸事故后幸存者的精神状况如何?目的了解技术性灾难事件所引起的PTSD的特点及影响因素.设计以一起重大爆炸事故幸存者为对象的病例-对照研究.单位一所省级精神卫生中心.对象2000-08/09乌鲁木齐市区某路段发生的一起特大爆炸事故后3～5个月仍在综合医院治疗的幸存者28例(研究组),对照组为一般人口学资料与之相匹配的正常人30例.方法由精神科医生向被试者说明测验的目的和意义,让被试者独立填写自行设计的一般情况调查表、症状自评量表(SCL-90)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、康奈尔医学指数(CMI)、应付方式问卷、社会支持评定量表;他评量表事件影响量表(IES)、应激反应症状清单.主要观察指标主要结局①技术性灾难事件引起PTSD的临床特征.②在技术性灾难事件中与PTSD发生有关的因素.次要结局研究组IES,CMI,SDS,SAS量表值与对照组的比较.结果22例(79%)幸存者符合PTSD的诊断标准.研究组与对照组在IES,CMI,SDS,SAS,SCL-90差异均有显著性(t=3.62～8.17,P均＜0.01).PTSD的诊断与创伤暴露程度呈正相关(r=0.420,P＜0.05),与对善后处理的满意程度呈负相关(r=0.420,P＜0.05);与IES评分及反映心理痛苦水平部分指标高度正相关(r=0.389～0.665,P＜0.01);IES评分与暴露程度高度正相关(r=0.478,P＜0.05).结论技术性灾难事件导致PTSD的发生率很高,主要与受伤时暴露程度和事件后对善后处理的满意程度有关系.

Post-traumatic stress disorder in the survivors of the tremendous explosion

BACKGROUND: Posttraumatic stress disorder(PTSD) arises as a delayed and /or protracted response to a stressful event or situation of an exceptionally threatening or catastrophic nature. There have been reports about natural disasters causing PTSD, but there have been few reports about PTSDcaused by technological disasters. Our study investigated the mental status of those survivors after a serious explosion.OBJECTIVE: To investigate the characteristics and the factors of impact of PTSD caused by technological disasters.DESIGN: A case controlled study of the survivors of a momentous explosion.SETTING: A provincial mental health center.PARTICIPANTS: A serious explosion happened in Urumqi on September 8, 2000. Twenty-eight survivors(as the study group) who were still hospitalized for treatment 3 -5 months after the accident were involved in this study. And in the control group were 30 normal persons whose general demographic data were the same as those patients.METHODS: A psychiatrist told the subjects the following: The objective and meaning of the test, and explained the self-making questionnaire about their general condition, symptom checklist (SCL-90), self-rating anxiety scale (SAS), self-rating depression scale(SDS), cornell medical index(CMI), the questionnaire on dealing styles, the questionnaire on social support, and others-evaluating scale, incident effect scale(IES); a list of stress reaction symptoms.MAIN OUTCOME MEASURES:Main resulta:①Clinical feature of PTSD caused by the technological disaster.②the related factors to PTSD in the technologal disaster.Secondary results: Comparison of the results between the two groups in IES, CMI, SDS and SAS.RESULTS: A total of 22(79% ) survivors met the criteria as PTSD. There were significant differences in all the assessments(IES, CMI, SDS, SAS,SCL-90) between the study group and the control group (t =3.62-8.17, P ＜ 0.01 ) . The diagnosis of PTSD was positively correlated with the level of traumatic exposure( r = 0. 420, P ＜ 0. 05), and negatively correlated with the degree of satisfaction with the post-event solutions( r = 0. 420, P＜ 0.05), positively correlated with IES scoring and the level of heart pain ( r = 0. 389 - 0. 665, P ＜ 0. 01 ) . The total scores of IES were positively correlated with the level of exposure ( r = 0. 478, P ＜ 0.05 ).CONCLUSION: The incidence of PTSD after explosion was high, and its occurrence was related with the degree of exposure in the event and that of the satisfaction with the post-event solutions.