Early psychological reactions to life-threatening injuries
Early psychological reactions to life-threatening injuries
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DOI：
10.1097/00003246-200001000-00014
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发表时间：
2000-01-01
影响因子：
8.8
通讯作者：
Buddeberg, C
中科院分区：
文献类型：
--
作者：
Schnyder, U;Mörgeli, H;Buddeberg, C
目的：了解严重事故受害者创伤后应激症状的患病率及应对方式；研究损伤严重程度和心理社会变量与创伤后应激症状之间的相关性；并分析重症监护病房（ICU）人员与患者特征相关的整体临床评估。设计：一项对创伤后一个月内的危重事故受害者进行评估的研究。地点：苏黎世大学医院创伤科ICU。患者：1996年1月至1997年6月ICU连续收治意外伤害患者121例（平均伤害严重程度评分21.8分，格拉斯哥昏迷评分14.4分），年龄18-68岁。严重头部受伤、企图自杀和身体攻击的患者被排除在外。测量方法：广泛的临床访谈、事件影响量表、临床管理的创伤后应激障碍量表、社会支持、生活事件、传记保护和危险因素、一致性问卷、Freiburg疾病应对问卷。结果：事故发生后13,7 (SD, 6.8) d，除时间标准外，5例（4.1%）患者符合创伤后应激障碍的所有标准。另有24例（19.9%）患者有亚综合征性创伤后应激障碍。创伤后精神病学症状与客观损伤标准无关，而与创伤前变量（女性性别、传记风险和保护因素、生活事件）、患者对事故严重性和威胁的主观评价、总体生活态度（“连贯感”）以及当前应对策略相关。外科医生和护士的总体临床评估与损伤严重程度或患者的应对策略无关。结论：创伤外科医生和ICU工作人员在记录病历时应特别注意患者所接触的紧张和应激源，以及患者创伤前的社会心理适应水平。
Objective: To assess the prevalence of posttraumatic stress symptoms and coping patterns in severely injured accident victims; to study correlations between injury severity and psychosocial variables and the presence of posttraumatic stress symptoms; and to analyze intensive care unit (ICU) personnel's global clinical appraisals in relation to patient characteristics.Design: A study of critically ill accident victims assessed within one month of the trauma.Setting: ICU of the traumatology department at the University Hospital, Zurich.Patients: 121 consecutive patients with accidental injuries (mean Injury Severity Score, 21.8; mean Glasgow Coma Scale score, 14.4) admitted to the ICU between January 1996 and June 1997, aged 18-68 yrs. Patients with severe head injuries, attempted suicides, and victims of physical assault were excluded.Measurements: Extensive clinical interview, Impact of Event Scale, Clinician-Administered Posttraumatic Stress Disorder Scale, social support, life events, biographical protective and risk factors, Sense of Coherence questionnaire, Freiburg Questionnaire of Coping with Illness.Results:13,7 (SD, 6.8) days after the accident, 5 patients (4.1%) met all criteria for posttraumatic stress disorder with the exception of the time criterion. A further 24 patients (19.9%) had subsyndromal posttraumatic stress disorder. Posttraumatic psychiatric symptomatology did not correlate with objective injury criteria, but rather with pretrauma variables (female gender, biographical risk and protective factors, life events), the patients' subjective appraisal of the severity and threat of the accident, their general attitude toward life ("sense of coherence"), and their current coping strategies. Surgeons' and nurses' global clinical appraisals did not correlate with injury severity or with the patients' coping strategies.Conclusions: Trauma surgeons and ICU personnel should pay special attention to the strains and stressors their patients have been exposed to when recording case histories and to the level of their patients' psychosocial adaptation before the trauma.