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目的:联合临床心理科与创伤外科对外科多发性创伤伴发急性应激障碍(ASD)患者进行研究,探寻综合医院ASD患者合理有效易操作的联合干预方法。方法:对多发性创伤后符合美国精神疾病诊断标准(DSM-IV-TR)ASD诊断的60例患者随机将30名设为联合干预组,30名设为对照组。联合干预组采用药物治疗加心理联合干预,心理联合干预方法有:情绪管理训练、自助小册子、认知疗法,针对家属的团体辅导,心理联合干预时间共4周,对照组仅采用药物治疗和一般支持治疗,在治疗前后采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、事件影响量表(IES-R)进行检测。结果:经治疗后联合干预组的HAMD量表分低于对照组,差异均有统计学意义(t=-2.780,P=0.007);HAMD减分率高于对照组,差异均有统计学意义(t=-2.833,P=0.006);联合干预组的HAMD量表分低于对照组,差异均有统计学意义(t=-3.670,P=0.001);HAMD减分率高于对照组,差异均有统计学意义(t=3.776,P=0.000);联合干预组的IES-R量表总分低于对照组,差异均有统计学意义(t=-2.120,P=0.038)。结论 :药物治疗加心理治疗联合干预更能改善多发性创伤ASD患者的情绪状态及应激症状。
OBJECTIVE: To study the combination of clinical psychology and traumatic surgery in patients with surgical multiple trauma associated with acute stress disorder (ASD) and to explore a reasonable and effective intervention method for ASD patients in general hospital. Methods: Sixty patients diagnosed as having multiple trauma with DSM-IV-TR ASD were randomly assigned to 30 intervention groups and 30 to control group. The intervention group used the combination therapy and psychotherapy. The methods of psychological intervention include emotional management training, self-help pamphlet, cognitive therapy, group counseling for relatives, psychological intervention time of 4 weeks, control group only using drug therapy and General supportive care was performed before and after treatment with the Hamilton Anxiety Scale (HAMA), the Hamilton Depression Rating Scale (HAMD), and the Incident Impact Scale (IES-R). Results: After treatment, the HAMD score in the combined intervention group was lower than that in the control group (t = -2.780, P = 0.007), and the reduction rate of HAMD was higher than that in the control group (t = -2.833, P = 0.006). The HAMD score in the combined intervention group was lower than that in the control group (t = -3.670, P = 0.001) (T = 3.776, P = 0.000). The total score of IES-R in the combined intervention group was lower than that in the control group, with significant difference (t = -2.120, P = 0.038). Conclusion: Medication and psychotherapy combined intervention can improve the emotional status and stress symptoms in patients with multiple traumatic ASD.