脊髓損傷患者創傷後壓力症候群之盛行率及相關因子研究

The Prevalence and Related Factors of Posttraumatic Stress Disorder among Subjects with Spinal Cord Injury

張清棊(Ching-Chi Chang) ； 楊喻婷(Yu-Ting Yang) ； 游舒涵(Shu-Han Yu) ； 張乃引(Nai-Yin Chang) ； 陳錦宏(Vincent Chin-Hung Chen) ； 蔡素如(Su-Ju Tsai)

《台灣復健醫學雜誌》 42卷2期 (2014/06) Pp. 111-120

https://doi.org/10.6315/2014.42(2)05

摘要

台灣每年約有1200人因創傷導致脊髓損傷，發生的盛行率逐漸上升。創傷性脊髓損傷常導因於車禍、暴力行為、跌倒或運動傷害，這些皆可能導致患者罹患創傷後壓力症候（posttraumatic stress disorder），產生痛苦經驗再現、逃避反應麻木、過度警覺等症狀，影響患者在社交、就業、其他功能之表現，甚至導致失能。國外的研究指出，脊髓損傷患者符合創傷後壓力疾患診斷的盛行率由7%到20%不等。本研究目的在探討脊髓損傷患者罹患創傷後壓力症候群的盛行率以及相關影響因子，以呈現出台灣地區患者的特性。本研究收集67名脊髓損傷患者，以及無脊髓損傷病史的一般社群民眾116名。以事件影響測量表修訂版（Impact of Event Scale-Revised, IES-R）作為診斷創傷後壓力症候群之判斷準則，以分數大於或等於25分作為創傷後壓力症候群診斷臨界值，分析脊髓損傷患者在性別、年齡、婚姻狀態、脊髓損傷受傷時間、受傷部位、受傷程度，以及巴氏量表分數與創傷後壓力症候群之相關性。研究結果顯示，創傷後壓力症候群在一般社群的盛行率為5.2%，在脊髓損傷患者的盛行率為22.4%，兩者在統計學上有顯著差異（p＜.001）。相關因子的變項分析，發現當患者受傷時間超過一年以上者，IES-R量表分數顯著增高（p＜.05），其餘變項則無統計學上明顯相關。本研究以IES-R量表進行評估，呈現出台灣地區脊髓損傷患者罹患創傷後壓力症候群症狀之盛行率為22.4%，較一般社群明顯增加，且受傷時間越久症狀越顯著，值得作為臨床照護脊髓損傷患者之重要參考。

關鍵字

脊髓損傷 ； 創傷後壓力症候群 ； 盛行率

並列摘要

There are approximately 1200 new cases of traumatic spinal cord injury (SCI) each year in Taiwan. Traumatic SCI often results from motor vehicle crashes, acts of violence or sports injuries. These are potentially leading patients to suffer from posttraumatic stress disorder (PTSD). The characteristic symptoms of PTSD include persistent re-experiencing of the event, increased arousal and avoidance of stimuli associated with the trauma and numbing of general responsiveness. The symptoms must cause clinically significant distress or impairment in social, occupational or other important areas of functioning. Our purpose was to identify the prevalence and related factors of posttraumatic stress disorder among spinal cord injury patients in Taiwan. A total of 67 patients with traumatic SCI and 116 general population members were enrolled. PTSD was measured by the Impact of Event Scale-Revised (IES-R) with cutoff point ≧25. Sex, age, marriage, injury duration, paraplegia, tetraplegia, severity of SCI and Barthel index were analyzed to evaluate the relationship to PTSD. In this study, the prevalence of PTSD was 5.2% in the general population and 22.4% in traumatic SCI (p＜.001). The score of IES-R was higher in SCI patients with injury duration exceeding one year (p＜.005). Therefore, we concluded the prevalence of PTSD in SCI patients was significantly higher than those without SCI history. The severity of PTSD was related to the duration after injury.

並列關鍵字

spinal cord injury ； posttraumatic stress disorder ； prevalence