燒傷之心身醫學觀

Psychosomatic Aspects of Burn Injury

吳其炘(Chi-Shin Wu) ； 李明濱(Ming-Been Lee)

《北市醫學雜誌》 1卷3期 (2004/07) Pp. 252-260

https://doi.org/10.6200/TCMJ.2004.1.3.02

摘要

台灣每年約有17萬的燒傷病患,國內外的研究報告己指出,燒傷病患有較高的精神疾病患度,且合併一系列的身心問題,但台灣地區有關這方面的研究仍相當有限。本文旨在系統性地回顧 關文獻,以提供臨床與研究的參考。根據國外的報告,燒傷病患在燒傷前具有某些重要的前置因素，譬如有較高比率的憂鬱症、酒癮、物質濫用、人格異常、認知功能障礙、其他精神疾患以及家庭功能失調。病患在歷經急性期、適應期及復健期會分別面臨不同的生理心理社會的衝擊。譬如:急性期的譫妄症與創傷後壓力症適應期的疼痛與容貌毀損復健期的身心復健、家庭及職業功能題。而在影響身心適應的預後因子研究發現不良預後因子包括:1 )燒傷前即罹患精神疾患，如格疾患、憂鬱症、酒精或物質濫用等;)燒傷相關的直接因素如燒傷面積大、身體功能受限、以及可見疤痕; 3)社會因素:如家庭支持與社會福利補助差。臨床上宜針對高危險群病態,給予適當的精神治療與照顧,並應結合社區專業及非專業資源,做整體性及持續性的跨科整合照護。未來在研究方面國內應針對燒傷病患精神疾病的流行病學、影響心理社會功能之預後因于以及精神科治療成效評估做進一步的研究。

關鍵字

燒傷 ； 心身醫學 ； 照會精神醫學

並列摘要

In Taiwan, about 170,000 persons per year become new burn injury cases. Based on 2002 data reported )y the Bureau of National Health Insurance (Taiwan), 178,975 burn patients, 0.8% of the total Taiwan population, were registered for medical treatment. The psychological and psychiatric issues of burn injuries have intrigued health professionals for years; however, research in this area in Taiwan is still underdeveloped. The authors aim to integrate the comprehensive psychosomatic aspects of the burn injuries through a systematic literature review.
Based on research outside Taiwan, burn patients have a high incidence of psychological distress and psychiatric illness. The consulting psychiatrist plays a crucial role in the care and management of the burn patients during and after hospitalization at different clinical phases, the burn patient experiences a series of different biopsychosocial impacts in: 1) the acute phase, 2) adaptive phase, and 3) the long-term rehabilitation phase. A higher percentage of burn patients have several predisposing factors for burn injuries, such as depression, alcoholism, substance
abuse, personality disorders, cognitive degeneration, or dementia, other chronic mental illness and family dysfunction. During the acute phase, between 19 and 57% of burn patients develop delirium caused by stress and burn-induced metabolic disturbance. Although 3.in is a chronic crucial issue, it becomes most acute during changes of dressing and debridement. At the adaptive phase, patients cape with continued pain and disfigurement as the main issues. The rehabilitation phase may last for several years; therefore, the patients will face difficulties with physical and Psychosocial rehabilitation, return to the communi1y after rehabilitation, communication with family and friends, and Possible loss of employment.
The following factors contribute to the development of mental illness and psychosocial impairment in burn patients: 1) pre-burn psychiatric illness such as
3rsonality disorder, depression, alcohol or other substance abuse; 2) burn-related factors such as larger total burn surface area, physical dysfunction, and visible scars; and, 3) social factors such as poor family support and inadequate public welfare. In this review, we also discuss the related psychosocial and psychiatric interventions for burn patients. Other than medical treatment, a close liaison with social resources is considered an important avenue to promoting quality care of burn patients. In conclusion, we should provide 3.dequate psychiatric management for the high-risk burn patients. In future research endeavors, we will conduct an epidemiological survey of psychiatric comorbidities, identify the prognostic factors, and evaluate the effects of psychiatric intervention for burn patients. (Full text in Chinese)
I{{}ey Words: burn, psychosomatic medicine, consultation psychiatry

並列關鍵字

burn ； psychosomatic medicine ； consultation psychiatry