烧伤急性期患者心理应激反应的相关因素分析

背景:烧伤是一种心身创伤,烧伤后的心理创伤反应的强弱与个性、个人经历、社会支持可能有关。目的:调查急性期烧伤患者的心理应激反应、社会支持程度、明尼苏达多相人格特点,分析心理应激反应的影响因素。设计:横断面调查。单位:四川大学华西精神卫生中心,绵阳市中心医院烧伤科,攀枝花钢铁公司总医院烧伤科。对象:选择2003-04/2005-04绵阳市中心医院、攀钢总医院烧伤专科的住院患者104例,均为轻、中、重度热力烧伤,男92例,女12例;年龄12～60岁。方法:于烧伤后3d内进行量表评定,包括汉密顿抑郁量表、汉密顿焦虑量表、明尼苏达多相人格调查表、社会支持评定量表及临床一般资料。按汉密顿抑郁量表、汉密顿焦虑量表的分值(焦虑>7分,抑郁>8分是焦虑抑郁情绪),分为有焦虑抑郁情绪组51例和正常情绪组53例。以汉密顿焦虑量表和汉密顿抑郁量表得分为因变量,进行逐步回归分析,筛选出影响患者焦虑和抑郁的主要因素。主要观察指标:①两组患者各项量表评分及一般临床资料比较。②影响烧伤患者抑郁、焦虑情绪的逐步回归分析。结果:104例患者均进入结果分析。①烧伤急性期有焦虑抑郁情绪患者焦虑评分为10.4±2.46、抑郁评分为16.8±5.94,均明显高于正常组(4.29±2.26,5.48±2.06)(P=0.00)。②抑郁的主要影响因素为烧伤总面积和社会支持利用度,焦虑的主要影响因素为年龄、烧伤总面积、社会支持的利用度、主观社会支持度。③明尼苏达多相人格调查表测试结果,在焦虑抑郁情绪组中各分量表T分均在正常范围,在正常组中诈分、轻躁狂、精神分裂、精神衰弱、偏执分量表T分大于60分。结论:烧伤对于患者来说是心理危机,可引起机体的个性偏移或情绪反应。烧伤后的焦虑抑郁情绪与烧伤的面积正相关,与社会支持利用度呈负相关。良好的家庭支持系统更有利于患者渡过心理危机期。

Correlation factor analysis of mental stress reaction of patients during acute burn period

BACKGROUND: There is often a physical and psychosocial effect in burn injury, and the degree of mental stress reaction is related to social support, individual experience and personality characteristics.OBJECTIVE: To investigate the mental stress reaction, the degree of social support and the Minnesota Multiphasic Personality Inventory (MMPI)personality characteristics in acute burn patients, and to analysis the influence factor of mental stress reaction.DESIGN: Cross-sectional study.SETTING: West China Mental Health Center of Sichuan University, Burn Department of Mianyang Municipal Central Hospital, and Burn Department of General Hospital of Panzhihua Iron and Steel Company.PARTICIPANTS: From April 2003 to April 2005, totally 104 mild, moderate or severe burn patients, including 92 males and 12 females, aged 12-60 years, selected from Mianyang Central Hospital and Department of burn of General Hospital of Panzhihua Iron & Steel Co., Ltd took part in the study.METHODS: The emotional problems and personality characteristics were measured with the Hamilton Rating Scale for Depression (HAMD), the Hamilton Rating Scale for Anxiety (HAMA), the Minnesote Multiphasic Personality Inventory (MMPI), the Social Support Rating Scale (SS) as well as general clinical data,by the rating scales 3 day after burn. The patients were divided into anxiety-depression group (n=51) and normal emotion group (n=53) according to their anxiety-depression scores (anxious score＞ 7,depressive score＞ 8), those influencing factor included burning total area,age, sex and society support, Stepwise Regression was introduced to get the main factors that influenced mental stress reaction.MAIN OUTCOME MEASURES: ① Scores of each scale and comparison of general clinical data in each group; ② stepwise regression analysis of depression and anxiety of burn patients.RESULTS: Data of Totally 104 patients was entered the final analysis. ①The scores were 10.4±2.46 and 16.8±5.94 of anxious and depressive patients during acute burn period, which were higher than those in normal group (4.29±2.26, 5.48±2.06, P=0.01). ② The main influential factor for depression were burning area and social supporting availability, and those for anxiety were age, burning area, social supporting availability and subjective social supporting degree. ③ MMPI test results show that T scores in anxiety-depression group were below 60 points, however T-scores were above 60 points in normal group including cheating points, hypomania,schizophrenia, psychasthenia and paranoid ideation CONCLUSION: Burn is a mental crisis to burn patients, which can lead to abnormal emotional reaction and personality change. The depressive and anxious score are positively related with burning area, and are negatively correlated with society supporting availability. The good social support system is benefit to over mental crisis period.