车祸颅脑损伤患者康复治疗期抑郁心理发生的危险因素
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摘要
目的:探讨车祸颅脑损伤患者康复治疗期抑郁心理发生的危险因素。方法:以2015年11月-2016年10月我院收治的130例车祸颅脑损伤康复治疗期患者为对象,采用汉密尔顿抑郁量表17项(HAMD-17)对纳入患者康复治疗期抑郁心理状况进行评估诊断,观察纳入患者治疗前、康复治疗期HAMD评分变化,依据评估结果将患者分为抑郁组(HAMD-17>7分)及无抑郁组(HAMD-17≤7分),分析比较两组一般资料及社会支持评定量表(SSRS)评分,采用单因素和多因素Logistic回归分析法分析车祸颅脑损伤患者康复治疗期抑郁心理发生的危险因素。结果:纳入患者康复治疗期HAMD评分较治疗前及国内常模明显高,差异显著(t=11.697,27.837;P<0.001);纳入研究130例患者共有80例存在抑郁症,抑郁症发生率为61.54%(80/150);经单因素和多因素Logistic回归分析显示年龄小(OR=-0.321,P=0.012,95%CI=1.017～1.282)、文化程度高(OR=-0.519,P=0.007,95%CI=1.011～2.208)、经济状况差(OR=-0.605,P=0.016,95%CI=1.154～3.430)、无经济赔偿(OR=-0.552,P=0.013,95%CI=1.213～3.983)、颅脑损伤程度高(OR=-0.712,P=0.016,95%CI=1.301～3.992)、有昏迷(OR=-0.313,P=0.014,95%CI=1.001～2.128)和SSRS评分低(OR=-0.449,P=0.005,95%CI=1.009～2.198)是车祸颅脑损伤患者康复治疗期抑郁心理发生的独立危险因素。结论:车祸颅脑损伤患者康复治疗期存在抑郁心理发生风险较高,其危险因素主要包含年龄小、文化程度高、社会支持性差、颅脑损伤程度高等,临床工作中应高度重视其高危因素,对指导合理干预措施有重要参考价值。
Objective:To investigate the risk factors of depression in patients with craniocerebral injury caused by traffic accident during rehabilitation treatment.Methods:A total of 130 patients with craniocerebral injury during rehabilitation treatment who were treated in the hospital from November 2015 to October 2016 were selected as study subjects.The status of depression in patients during the rehabilitation treatment was evaluated with the 17-item Hamilton Depression Scale(HAMD-17).Changes of HAMD scores before treatment and during the rehabilitation treatment were observed.According to the evaluation results,the patients were divided into the depression group(HAMD-17score>7points)and the non-depression group(HAMD-17score≤7points).The general data and scores of the Social Support Rating Scale(SSRS)were analyzed and compared between the two groups.The risk factors of depression in patients with craniocerebral injury caused by traffic accident during rehabilitation treatment were analyzed by univariate and multivariate Logistic regression analyses.Results:The HAMD score of the subjects during the rehabilitation treatment was significantly higher than that before the treatment and that of domestic norm(t=11.697,27.837,P<0.001).Of the 130 subjects,80patients had depression,and the incidence of depression was61.54%(80/150).Univariate and multivariate Logistic regression analyses showed that younger age(OR=-0.321,P=0.012,95%CI 1.017～1.282),high education level(OR=-0.519,P=0.007,95%CI 1.011～2.208),poor economic status(OR=-0.605,P=0.016,95%CI 1.154～3.430),no economic compensation(OR=-0.552,P=0.013 95%CI1.213～3.983),high degree of craniocerebral injury(OR=-0.712,P=0.016,95%CI 1.301～3.992),coma(OR=-0.313,P=0.014,95%CI 1.001～2.128)and low SSRS score(OR=-0.449,P=0.005,95%CI 1.009～2.198)were independent risk factors of depression in patients with craniocerebral injury caused by car accident during rehabilitation treatment.Conclusion:The risk of depression is relatively higher in patients with craniocerebral injury caused by car accident during rehabilitation treatment.The main risk factors include age,high education level,poor social support and high degree of craniocerebral injury,etc.Attention should be paid to the risk factors to guide the reasonable intervention.
Objective:To investigate the risk factors of depression in patients with craniocerebral injury caused by traffic accident during rehabilitation treatment.Methods:A total of 130 patients with craniocerebral injury during rehabilitation treatment who were treated in the hospital from November 2015 to October 2016 were selected as study subjects.The status of depression in patients during the rehabilitation treatment was evaluated with the 17-item Hamilton Depression Scale(HAMD-17).Changes of HAMD scores before treatment and during the rehabilitation treatment were observed.According to the evaluation results,the patients were divided into the depression group(HAMD-17score>7points)and the non-depression group(HAMD-17score≤7points).The general data and scores of the Social Support Rating Scale(SSRS)were analyzed and compared between the two groups.The risk factors of depression in patients with craniocerebral injury caused by traffic accident during rehabilitation treatment were analyzed by univariate and multivariate Logistic regression analyses.Results:The HAMD score of the subjects during the rehabilitation treatment was significantly higher than that before the treatment and that of domestic norm(t=11.697,27.837,P<0.001).Of the 130 subjects,80patients had depression,and the incidence of depression was61.54%(80/150).Univariate and multivariate Logistic regression analyses showed that younger age(OR=-0.321,P=0.012,95%CI 1.017～1.282),high education level(OR=-0.519,P=0.007,95%CI 1.011～2.208),poor economic status(OR=-0.605,P=0.016,95%CI 1.154～3.430),no economic compensation(OR=-0.552,P=0.013 95%CI1.213～3.983),high degree of craniocerebral injury(OR=-0.712,P=0.016,95%CI 1.301～3.992),coma(OR=-0.313,P=0.014,95%CI 1.001～2.128)and low SSRS score(OR=-0.449,P=0.005,95%CI 1.009～2.198)were independent risk factors of depression in patients with craniocerebral injury caused by car accident during rehabilitation treatment.Conclusion:The risk of depression is relatively higher in patients with craniocerebral injury caused by car accident during rehabilitation treatment.The main risk factors include age,high education level,poor social support and high degree of craniocerebral injury,etc.Attention should be paid to the risk factors to guide the reasonable intervention.
引文
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[13]刘堂龙,秦天星,夏树剑,等.颅脑损伤患者康复期抑郁情绪及相关因素分析[J].中国康复理论与实践,2012,18(6):583-585
[14]牟丹,邓艳琼,黄淑仪,等.颅脑损伤引发精神障碍病例的特征及危险因素分析[J].中国公共卫生,2015,25(3):90-92
[15]Roberts D J,Hall R I,Kramer A H,et al.Sedation for critically ill adults with severe traumatic brain injury:A systematic review of randomized controlled trials[J].Critical Care Medicine,2011,39(12):2743-2751
[16]王磊,吕悦,赵玉研,等.交通伤患者刨伤后应激障碍的特点及影响因紊[J].中国健康心理学杂志,2015,23(9):1430-1433
[2]姚海军,胡锦,袁强,等.3144例重型颅脑损伤住院患者临床特点分析[J].山东医药,2015,21(30):67-69
[3]李春伟,伊志强,李良.重型创伤性颅脑损伤的治疗进展[J].中国微创外科杂志,2016,16(7):656-660
[4]杨向丽,王毅,陈旭义,等.中重度颅脑外伤睡眠障碍伴发焦虑、抑郁及疼痛的临床分析[J].重庆医学,2016,45(6):721-723
[5]Liu H R.Comparison of the effects of mirtazapine versus sertralinein treatment of depression after craniocerebral trauma[J].Chinese Journal of Clinical Pharmacy,2007,620(2):15549-15573
[6]刘玉玲,丁峰,梅亚萍.心理护理干预在颅脑损伤患者高压氧治疗中的作用[J].安徽医学,2015,36(8):1017-1019
[7]霍龙伟,陈晨,郑虎林,等.影响颅脑损伤后精神障碍的相关危险因素分析[J].国际精神病学杂志,2015,42(4):49-52
[8]侯彩兰,刘毅,许明智,等.颅脑损伤后抑郁障碍的相关因素[J].广东医学,2015,21(1):20-22
[9]郑晓静,王智民,周福春,等.综合医院重性抑郁症患者生活质量及影响因素研究[J].中国预防医学杂志,2017,23(2):144-146
[10]何小燕,王睿,马梁红,等.多发性创伤住院患者心理状况调查及影响因素[J].中国健康心理学杂志,2016,24(8):1141-1144
[11]刘建民,孙鸿,黄良才,等.颅脑损伤后抑郁的发生情况及影响因素研究[J].现代预防医学,2011,38(13):2535-2536,2538
[12]秦天星,郭细先,张连仲,等.车祸所致颅脑损伤患者恢复期抑郁相关因素分析[J].浙江医学,2016,38(10):735-738
[13]刘堂龙,秦天星,夏树剑,等.颅脑损伤患者康复期抑郁情绪及相关因素分析[J].中国康复理论与实践,2012,18(6):583-585
[14]牟丹,邓艳琼,黄淑仪,等.颅脑损伤引发精神障碍病例的特征及危险因素分析[J].中国公共卫生,2015,25(3):90-92
[15]Roberts D J,Hall R I,Kramer A H,et al.Sedation for critically ill adults with severe traumatic brain injury:A systematic review of randomized controlled trials[J].Critical Care Medicine,2011,39(12):2743-2751
[16]王磊,吕悦,赵玉研,等.交通伤患者刨伤后应激障碍的特点及影响因紊[J].中国健康心理学杂志,2015,23(9):1430-1433
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