玉树地震灾区伤病员手术后病情评估
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摘要
目的:评估玉树地震灾区伤病员手术后心理、疼痛、功能、内环境变化以及经心理疏导、疼痛治疗、功能锻炼后再次进行评估,分析康复情况。方法:于2010年9月收集玉树地震时经受创伤并在玉树残疾人联合会康复中心进行康复治疗认知功能正常的手术后患者,进行心理、疼痛、功能、内环境评估,根据评估结果进行有针对性的心理疏导、疼痛治疗、功能锻炼后,于2011年3月再次到原地进行调查、评估,比较、分析两次评估及患者康复情况。结果:①心理评估:症状自评量表(SCL-90)两次评估总分均超过160分,总均分为2.07±0.48、1.87±0.53,因子分≥2的为7个、2个。汉密尔顿焦虑量表(HAMA)总分两次评估均大于8分,大于20分分别为占当时评估人数的17.8%、22.2%。精神性因子分和躯体性因子分两大类两次评估分别为15±5、16±6和7±3、5±2。汉密顿抑郁量表(HAMD)总分两次评估均大于7分,大于24分占当时评估人数的7.1%、13.1%;②疼痛、功能、内环境评估、疼痛评估:第一次调查视觉模拟评分(VAS)评分≤3分的有24人,VAS:(4-6)分的有27人,VAS评分≥7分的有5人。第二次回访人数为VAS评分≤3分的有23人,VAS评分(4-6)分的有13人,VAS评分≥7分的有2人,占总人数的5.3%。功能评估:两次评估中术后伤员上下肢的肌力大多数为(Ⅳ-Ⅴ)级,运动功能障碍评估多为(Ⅰ-Ⅱ)级,第二次运动功能明显好于第一次。远期生活质量评估由第一次(60-80)分上升至第二次(70-90)分。内环境评估两次内环境监测各项目相比红细胞比积(Hct)有差异(P<0.05),但两次监测二氧化碳总量(TCO2)、二氧化碳分压(PCO2)、氧分压(PO2)、血氧饱和度(SO2)均低于正常值,Hct、血红蛋白(Hb)、Na均位于正常值的高位,离子检测基本在正常值范围内。结论:玉树地震灾区手术后伤病员心理疾病和创伤后应激障碍症状发生率高,但症状评分不是很严重,随着时间的推移创伤后应激障碍症状如躯体化、敌对、恐惧等逐渐好转,但抑郁、焦虑有所加重,经过治疗后疼痛、功能较前明显好转。
Objective: To evaluate physiological conditions,pains,body functions and changes of internal environment after and before rehabilitation treatment in postoperative patients in Yushu earthquake.Methods: We collected 56 cases of wounded patients who underwent operation in Yushu earthquake and who have normal evaluation of cognitive function by Rehabilitation Center of Yushu Disabled Persons' Federation In September 2010,and 38 relative patients who need reevaluation in March 2011.Physiological conditions,pains,body functions and internal environments were evaluated by symptom checklist 90(SCL-90),Hamilton depressive scale(HAMD),Hamilton anxiety scale(HAMA),visual analogue scale(VAS) and muscle strength score.Results: ①The score between front and back investigation of the SCL-90 was that: the total score exceeded 160 points and average score of 2.07 ± 0.48 7 cases,1.87 ± 0.53 was for 2 cases and the factor score≥2;②The HAMA total scores between front and back exceeded 8 points,and score of 17.8% and 22.2% of subjects > 20.The Psychological factor score and body factor score between front and back is 15 ± 5,16 ± 6 and 7 ± 3,5 ± 2 respectively.The HAMD total scores between front and back exceed 7 points,and 7.1% and 13.1% of score > 24.In front investigation,there are 24 patients with the VAS score≤3 points,27 patients with the VAS score were 4 to 6 points,and 5 patients with the VAS score≥7 points;③In back investigation,23 patients with the VAS score≤3 points;4 to 6 points for 13 patients;and 2 patients≤7 points,accounting for 5.3% among all patients.The motor function was obviously better than that in front one.The life quality proved from 60-80 points in the first investigation to(70-90) points in the back one;④In functional Assessment,the myodynamia of the limbs was mostly at (Ⅳ-Ⅴ) level in the postoperative patients,and their dyskinesias were mostly at(1-2) level;⑤In internal Environment,there was a difference in Hct between the both investigation(P < 0.05),and level of TCO2,PCO2,PO2,and SO2 was lower than the normal level.Conclusions: The occurrence rate of physiological illness and post-traumatic stress disorder is high in the postoperative patients in Yushu Earthquake but the symptom is not so serious.Along with time,post-traumatic stress disorders,such as somatization,hostility and fear,will decrease gradually and depression and anxiety will deteriorate.
Objective: To evaluate physiological conditions,pains,body functions and changes of internal environment after and before rehabilitation treatment in postoperative patients in Yushu earthquake.Methods: We collected 56 cases of wounded patients who underwent operation in Yushu earthquake and who have normal evaluation of cognitive function by Rehabilitation Center of Yushu Disabled Persons' Federation In September 2010,and 38 relative patients who need reevaluation in March 2011.Physiological conditions,pains,body functions and internal environments were evaluated by symptom checklist 90(SCL-90),Hamilton depressive scale(HAMD),Hamilton anxiety scale(HAMA),visual analogue scale(VAS) and muscle strength score.Results: ①The score between front and back investigation of the SCL-90 was that: the total score exceeded 160 points and average score of 2.07 ± 0.48 7 cases,1.87 ± 0.53 was for 2 cases and the factor score≥2;②The HAMA total scores between front and back exceeded 8 points,and score of 17.8% and 22.2% of subjects > 20.The Psychological factor score and body factor score between front and back is 15 ± 5,16 ± 6 and 7 ± 3,5 ± 2 respectively.The HAMD total scores between front and back exceed 7 points,and 7.1% and 13.1% of score > 24.In front investigation,there are 24 patients with the VAS score≤3 points,27 patients with the VAS score were 4 to 6 points,and 5 patients with the VAS score≥7 points;③In back investigation,23 patients with the VAS score≤3 points;4 to 6 points for 13 patients;and 2 patients≤7 points,accounting for 5.3% among all patients.The motor function was obviously better than that in front one.The life quality proved from 60-80 points in the first investigation to(70-90) points in the back one;④In functional Assessment,the myodynamia of the limbs was mostly at (Ⅳ-Ⅴ) level in the postoperative patients,and their dyskinesias were mostly at(1-2) level;⑤In internal Environment,there was a difference in Hct between the both investigation(P < 0.05),and level of TCO2,PCO2,PO2,and SO2 was lower than the normal level.Conclusions: The occurrence rate of physiological illness and post-traumatic stress disorder is high in the postoperative patients in Yushu Earthquake but the symptom is not so serious.Along with time,post-traumatic stress disorders,such as somatization,hostility and fear,will decrease gradually and depression and anxiety will deteriorate.
引文
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2 吴范武,金子环.症状自评量表调查研究中统计方法的正确应用.中国健康心理学杂志,2005,13(5):397-399.
3 张明圆.精神科评定量表手册.长沙:湖南科学技术出版社,2003,8.
4 苏珍,蔡伟,戴体俊,等.不同程度疼痛对定量药物脑电图的影响.实用医学杂志,2012,78(24):4 121-4 123.
5 郑志惠,刘晓华,傅爱凤.早期心理干预对创伤骨科病人焦虑的影响.现代护理,2005,11(16):1 289-1 290.
6 刘兰花,于玲玲,王燕.急性创伤骨折患者焦虑、抑郁实施心理干预的研究.中国实用神经疾病杂志,2009,12(14):85-86.
7 Fujite F,Lahmann B,Oysuka K,et al.Quntification of painand satisfaction following laparoscopic and pain hemia re-pair.Arch Sur J,2004,139(6):596-600.
8 吴天一.玉树灾后重建的卫生保健事关重大.高原医学杂志,2011,21(1):1.
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