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创伤性颅脑损伤(traumatic brain injury, TBI)是由于头部遭受直接或间接的暴力作用而引起的神经外科常见的疾病类型。重度TBI是病人致死、致残的主要原因,而中度和轻度TBI病人多有不同程度的运动、记忆力、注意力、抑郁等功能障碍[1]。虽然在伤后3~6个月内多数TBI病人伴有的这些症状逐渐恢复,但仍有20%~30%病人长期伴存。全世界每年有超过5 000万人发生TBI,给社会和家庭带来巨大负担[2]。心理弹性是指个体在遭受创伤、逆境以及应激性事件时个体与环境之间相互作用所表现积极向上的保护过程,即面对逆境的反弹能力。近年来心理弹性广泛应用于研究颅脑创伤后病人恢复期的生存质量[3]。在TBI恢复期心理弹性水平较高的病人,生活质量相对较高,疾病预后较好,较少出现脑震荡后遗症和创伤后应激障碍症状[4-6]。抑郁是由于不良因素刺激导致以情绪淡漠、少语、多眠或失眠、兴趣下降为主要表现的情绪变化,是TBI后病人出现类似精神障碍并发症时常见的类型之一,远高于普通人群的发病率,严重影响病人的生活质量[7]。研究[8]表明,抑郁与心理弹性水平存在负相关性,且积极的应对方式和自尊心的提升可显著提高心理弹性水平。但在TBI早期病人是否存在抑郁以及与心理弹性的关系尚不明确。本研究探讨抑郁和心理弹性的关系,并以此为循证护理依据,以期为早期TBI病人的护理提供理论支持。现作报道。
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选取2017年10月至2018年10月收治的创伤性颅脑损伤病人23例,其中男16例,女7例;年龄20~63岁。纳入标准:(1)入院时有明确颅脑外伤史,格拉斯哥昏迷指数(GCS)>8分,年龄≥18岁;(2)符合中度和轻度TBI诊断标准;(3)住院期间能配合完成量表检查。剔除标准:(1)既往有颅脑损伤史;(2)既往有精神病史(包括药物和酒精滥用史)和/或智力发育障碍史;(3)既往有脑血管意外及颅内病变史;(4)损伤前有认知障碍史。根据与TBI病人年龄、性别、受教育程度、宗教信仰及民族相匹配的原则,募集同期健康志愿者23名,其中男15名,女8名;年龄23~60岁。2组受试者年龄、性别、受教育程度差异均无统计学意义(P>0.05),具有可比性(见表 1)。2组受试者量表评估前均签署知情同意书。
分组 n 年龄/岁 男 女 教育程度/年 量表评估时间/d GCS评分/分 TBI组 23 37.46±10.38 16 7 11.53±3.16 7.63±2.38 9.85±2.52 对照组 23 36.72±11.39 15 8 10.82±3.73 — — t — 0.23 0.13* 0.70 — — P — >0.05 >0.05 >0.05 — — *示χ2值 表 1 2组受试者一般资料比较(x±s)
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测试者在测试前应获得心理学专业证书,并向被试者解释量表的目的和方法,由一名医生和一名护士共同完成。测试者应在安静的环境下按《使用手册》指导语逐项测试。
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根据GCS评分、伤后昏迷时间和伤后遗忘时间将TBI的损伤程度划分为轻度、中度和重度。GCS评分13~15分为轻度TBI,9~12分为中度TBI,本研究选择轻度和中度TBI为研究对象。
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心理弹性评估采用Connor-Davidson心理弹性量表(Connor and Davidson′s resilience scale, CD-RISC)。该量表由我国学者汉化,适应于中国人群。量表共25个条目,包含坚韧、自强和乐观三个维度,内部一致性系数为0.91。CD-RISC总分为100分,分为低水平心理弹性(总分0~56分)、中等水平心理弹性(总分57~70分)和高水平心理弹性(总分71~100分),量表得分越高,所对应的心理弹性水平越高。
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抑郁评估采用汉密顿抑郁量表(Hamilton depression rating scale,HAMD)。该量表由Hamilton于1960年编制,在我国也有较高的信度和效度,与临床上抑郁严重程度的相关系数为0.92,是应用最为广泛的评定研究对象抑郁状态的量表。本研究采用HAMD 24项版本,根据量表总分评定为无抑郁症(总分 < 8分)、可能有抑郁(总分8~20分)、肯定有抑郁(总分20~35分)和重度抑郁(总分>35分)
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采用t(或t′)检验、χ2检验和Pearson相关分析。
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TBI组病人CD-RISC量表自强、乐观维度得分和总分均低于对照组(P < 0.05~P < 0.01),HAMD-24量表得分明显高于对照组(P < 0.01)(见表 2)。
分组 n CD-RISC总分 坚韧维度 自强维度 乐观维度 HAMD-24 TBI组 23 55.32±12.46 29.53±6.27 16.35±2.19 6.58±2.72 19.13±5.91 对照组 23 63.78±13.57 32.67±6.27 21.16±3.75 9.37±2.04 12.68±3.87 t — 2.20 1.70 5.31# 3.94 4.38 P — < 0.05 >0.05 < 0.01 < 0.01 < 0.01 #示t′值 表 2 TBI组和对照组量表评分比较(x±s;分)
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Pearson相关分析结果显示,CD-RISC总分(r=0.782, P < 0.01)、坚韧维度(r=0.788, P < 0.01)、自强维度(r=0.702, P < 0.01)和乐观维度(r=0.657, P < 0.01)与GCS评分均呈明显正相关关系。CD-RISC总分(r=-0.676, P < 0.01)、坚韧维度(r=-0.648, P < 0.01)、自强维度(r=-0.607, P < 0.01)和乐观维度(r=-0.901, P < 0.01)与HAMD-24量表总分均呈明显负相关关系。
心理弹性与创伤性颅脑损伤后精神障碍的相关性研究
Study on the correlation between psychological resilience and psychogeny after traumatic brain injury
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摘要:
目的探讨心理弹性与创伤性颅脑损伤(TBI)后精神障碍之间的相关性。 方法选取TBI病人23例为研究对象。并与受教育程度、宗教信仰、民族类似的健康志愿者进行比较。使用Connor-Davidson心理弹性量表(CD-RISC)和汉密顿抑郁量表(HAMD),比较2组受试者量表评分的差异。对TBI组的心理弹性与GCS评分和HAMD-24量表总分行Pearson直线相关分析。 结果TBI组病人CD-RISC量表自强、乐观维度得分和总分均低于对照组(P < 0.05~P < 0.01),HAMD-24量表得分明显高于对照组(P < 0.01)。CD-RISC总分、坚韧维度、自强维度和乐观维度与GCS评分、HAMD-24量表总分均呈明显相关关系(P < 0.01)。 结论心理弹性可以作为临床TBI病人的循证护理证据,为该类病人的护理提供一定理论支持。 Abstract:ObjectiveTo explore the correlation between psychological resilience and psychogeny after traumatic brain injury. MethodsTwenty-three patients with traumatic brain injury(TBI group) were selected, and compared with healthy volunteers with similar education, religion and ethnicity(control group).The differences of the scores of Connor-Davidson mental resilience scale(CD-RISC) and Hamilton depression rating scale(HAMD) between two groups were comapred.The correlation of psychological resilience with GCS score and total score of HAMD-24 scale in TBI group were analyzed using Pearson linear correlation analysis. ResultsThe scores of self-improvement and optimism dimensions and total score of CD-RISC in TBI group were significantly lower than those in control group(P < 0.05 to P < 0.01), and the HAMD-24 score in TBI group was significantly higher than that in control group(P < 0.01).The total score of CD-RISC, tenacity dimension score, self-improvement dimension score and optimism dimension score were significnatly correlated with the GCS score and total score of HAMD-24 scale(P < 0.01). ConclusionsPsychological resilience can be used as evidence-based nursing proof for patients with TBI, and provide some theoretical support for the clinical care of such patients. -
Key words:
- traumatic brain injury /
- psychological resilience /
- psychogeny
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表 1 2组受试者一般资料比较(x±s)
分组 n 年龄/岁 男 女 教育程度/年 量表评估时间/d GCS评分/分 TBI组 23 37.46±10.38 16 7 11.53±3.16 7.63±2.38 9.85±2.52 对照组 23 36.72±11.39 15 8 10.82±3.73 — — t — 0.23 0.13* 0.70 — — P — >0.05 >0.05 >0.05 — — *示χ2值 表 2 TBI组和对照组量表评分比较(x±s;分)
分组 n CD-RISC总分 坚韧维度 自强维度 乐观维度 HAMD-24 TBI组 23 55.32±12.46 29.53±6.27 16.35±2.19 6.58±2.72 19.13±5.91 对照组 23 63.78±13.57 32.67±6.27 21.16±3.75 9.37±2.04 12.68±3.87 t — 2.20 1.70 5.31# 3.94 4.38 P — < 0.05 >0.05 < 0.01 < 0.01 < 0.01 #示t′值 -
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