学龄前儿童烧伤后心理应激障碍发生情况的横断面调查及影响因素分析

卢学兰; 刘应平; 刘一伟; 刁杰林; 王丰; 钟方宇; 何家乐; 陈朗

doi:10.3760/cma.j.cn501225-20230731-00028

学龄前儿童烧伤后心理应激障碍发生情况的横断面调查及影响因素分析

doi: 10.3760/cma.j.cn501225-20230731-00028

1.
川北医学院附属医院整形美容烧伤外科，南充　　637002
2.
遂宁市中心医院烧伤整形科，遂宁　　629099
3.
南充市中心医院烧伤整形美容外科，南充　　637003

基金项目:

四川省基层卫生事业发展研究中心重点项目 SWFZ22-Z-06

四川省医学会伤口疾病（泰阁）专项科研课题 2023TG02

南充市社科研究“十四五”规划2023年度项目 NC23B199

详细信息

通讯作者:
陈朗，Email：langchen@nsmc.edu.cn

计量
- 文章访问数: 51
- HTML全文浏览量: 11
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-31

A cross-sectional survey and analysis of influencing factors on the occurrence of post-burn psychological stress disorder in preschool children

1.
Department of Plastic Surgery and Burn Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637002, China
2.
Department of Burns and Plastic Surgery, Suining Central Hospital, Suining 629099, China
3.
Department of Burn, Plastic and Cosmetic Surgery, Nanchong Central Hospital, Nanchong 637003, China

Funds:

The Primary Health Development Research Center of Sichuan Province Program SWFZ22-Z-06

Special Scientific Research Project on Wound Diseases (Taige) of Sichuan Medical Association 2023TG02

Nanchong City Social Science Research "14th Five-Year Plan" 2023 Project NC23B199

More Information

Corresponding author: Chen Lang, Email: langchen@nsmc.edu.cn

摘要

摘要: 目的探讨学龄前儿童烧伤后心理应激障碍发生情况及其影响因素。方法该研究为多中心横断面调查。2022年1月—2023年2月，选择川北医学院附属医院、南充市中心医院、遂宁市中心医院、广安市人民医院、广元市中心医院收治的85例符合入选标准的1~6岁学龄前烧伤患儿为调查对象。采用自制一般信息调查表调查患儿性别、年龄段、居住地区、主要看护人及其文化程度、家庭类型等一般资料，以及致伤原因、烧伤严重程度等伤情；采用儿童应激障碍检查表调查患儿伤后3 d~1个月心理应激障碍发生情况，计算发生率。将患儿按照一般资料和伤情分类，统计患儿伤后3 d~1个月心理应激障碍发生情况，筛选学龄前儿童烧伤后发生心理应激障碍的影响因素。结果共发放调查问卷85份，收回有效问卷85份，有效回收率为100%。患儿中，男45例、女40例，以1~3岁年龄段患儿居多，农村地区患儿稍多于城市，主要看护人为父母和祖父母的患儿约各占1/2，主要看护人文化程度以高中/中专为主，家庭类型以核心家庭与扩大家庭为主，致伤原因以热液烫伤为主，烧伤严重程度以中度为主。该组患儿伤后3 d~1个月心理应激障碍发生率为34.12%（29/85）。不同年龄段、致伤原因、烧伤严重程度患儿伤后3 d~1个月心理应激障碍发生情况比较，差异均有统计学意义（ χ ²值分别为9.18、7.80、25.47， P<0.05）；不同性别、居住地区、主要看护人、主要看护人文化程度、家庭类型患儿伤后3 d~1个月心理应激障碍发生情况比较，差异均无统计学意义（ P>0.05）。多因素logistic回归分析显示，年龄段和烧伤严重程度均为学龄前儿童烧伤后发生心理应激障碍的独立影响因素（比值比分别为8.21、33.99，95%置信区间分别为1.57~43.04、5.55~207.93， P<0.05），患儿年龄越大、烧伤严重程度越重，发生心理应激障碍的可能性越高。结论学龄前儿童烧伤后心理应激障碍发生率高，年龄段和烧伤严重程度是该类患儿伤后发生心理应激障碍的独立影响因素。
- 烧伤 /
- 儿童，学龄前 /
- 应激障碍，创伤后 /
- 影响因素分析 /
- 心理应激障碍 /
- 急性应激障碍
Abstract: Objective To explore the occurrence and influencing factors of post-burn psychological stress disorder in preschool children. Methods This study was a multi-center cross-sectional survey. From January 2022 to February 2023, 85 preschool children (aged 1 to 6 years) with burns admitted to the Affiliated Hospital of North Sichuan Medical College, Nanchong Central Hospital, Suining Central Hospital, Guang'an People's Hospital, and Guangyuan Central Hospital who met the inclusion criteria were selected as respondents. A self-made general information questionnaire was used to investigate the children's general data including gender, age group, residential area, main caregiver and their education level, and family type, as well as the injury condition including cause of injury and burn severity. The Child Stress Disorders Checklist was used to investigate the occurrence of psychological stress disorder in children at 3 days to 1 month after injury, and the incidence rate was calculated. The children were classified according to their general data and injury condition, and the occurrence of psychological stress disorder in children at 3 days to 1 month after injury was recorded, and the influencing factors for post-burn psychological stress disorder in preschool children were screened. Results A total of 85 questionnaires were distributed and 85 valid questionnaires were recovered, with an effective recovery rate of 100%. Among the children, there were 45 boys and 40 girls, with most children aged 1 to 3 years. There were slightly more children in rural areas than in cities. About half of the children were mainly cared for by their parents and grandparents, respectively, and the education level of the main caregivers was mainly high school/technical secondary school. The family type was mainly core family and extended family. The main cause of injury was hydrothermal scald, and the severity of burns was mainly moderate. The incidence rate of psychological stress disorder in this group of children at 3 days to 1 month after injury was 34.12% (29/85). There were statistically significant differences in the occurrence of psychological stress disorder in children with different age groups, causes of injuries, and burn severity at 3 days to 1 month after injury (with χ ² valuesof 9.18, 7.80, and 25.47, respectively, P<0.05); there were no statistically significant differences in the occurrence of psychological stress disorder in children with different genders, residential area, main caregivers, main caregivers' education levels, or family types at 3 days to 1 month after injury ( P>0.05). Multivariate logistic regression analysis showed that age group and burn severity were independent influencing factors for the occurrence of psychological stress disorder in preschool children after burns (with odds ratios of 8.21 and 33.99, respectively, and 95% confidence intervals of 1.57-43.04 and 5.55-207.93, respectively, P<0.05), the older the child and the more severe the burn, the higher the possibility of the occurrence of psychological stress disorder. Conclusions The incidence rate of psychological stress disorder is high in preschool children after burns. Age group and burn severity are independent influencing factors for the occurrence of post-burn psychological stress disorder in this type of children.
- Burns /
- Child, preschool /
- Stress disorders, post-traumatic /
- Root cause analysis /
- Psychological stress disorder /
- Acute stress disorder
卢学兰：研究设计、数据分析、论文撰写；刘应平、刘一伟、刁杰林：资料收集；王丰、钟方宇、何家乐：数据整理、统计分析；陈朗：研究指导、论文修改、经费支持

所有作者均声明不存在利益冲突

HTML全文

下载: 全尺寸图片幻灯片

表1 85例学龄前儿童烧伤后3 d~1个月不同一般资料与伤情下心理应激障碍发生情况比较

表1. Comparison of the occurrence of psychological stress disorder in 85 preschool children at 3 days to 1 month after burns with different general data and injury condition

项目与类别	例数	构成比（%）	应激障碍（例）		χ ²值	P值
项目与类别	例数	构成比（%）	无	有	χ ²值	P值
性别
男	45	52.94	31	14	0.39	0.535
女	40	47.06	25	15	0.39	0.535
年龄段
1~3岁	66	77.65	49	17	9.18	0.002
4~6岁	19	22.35	7	12	9.18	0.002
居住地区
农村	48	56.47	31	17	0.08	0.774
城市	37	43.53	25	12	0.08	0.774
主要看护人
父母	42	49.41	28	14	0.02	0.880
祖父母	43	50.59	28	15	0.02	0.880
主要看护人文化程度
初中及以下	25	29.41	19	6	5.88	0.117
高中/中专	38	44.71	20	18
大学本科/专科	20	23.53	15	5
硕士研究生及以上	2	2.35	2	0
家庭类型
扩大家庭	34	40.00	21	13	0.60	0.895
核心家庭	34	40.00	24	10
留守家庭	14	16.47	9	5
单亲家庭	3	3.53	2	1
致伤原因
热液烫伤	65	76.47	48	17	7.80	0.005
火焰烧伤/其他	20	23.53	8	12	7.80	0.005
烧伤严重程度
轻度	38	44.71	36	2	25.47	<0.001
中度	42	49.41	18	24
重度	5	5.88	2	3
注：其他指接触烫伤

下载: 导出CSV

表2 影响学龄前儿童烧伤后发生心理应激障碍的多因素logistic回归分析结果

表2. Results of multivariate logistic regression analysis affecting the occurrence of psychological stress disorder in preschool children after burns

项目与分类	比值比	95%置信区间	P值
致伤原因热液烫伤（以火焰烧伤/其他为参照）	0.41	0.11~1.53	0.182
年龄段4~6岁（以1~3岁为参照）	8.21	1.57~43.04	0.013
烧伤严重程度中重度（以轻度为参照）	33.99	5.55~207.93	<0.001
注：其他指接触烫伤

下载: 导出CSV

表3 2个年龄段学龄前烧伤患儿的一般资料与伤情比较（例）

表3. Comparison of general data and injuries of preschool children with burns in two age groups

年龄段	例数	性别		居住地区		主要看护人		主要看护人文化程度
年龄段	例数	男	女	农村	城市	父母	祖父母	初中及以下	高中/中专	大学本科/专科	硕士研究生及以上
1~3岁	66	34	32	36	30	34	32	20	28	16	2
4~6岁	19	11	8	12	7	8	11	5	10	4	0
χ ²值		0.24		0.45		0.52		1.06
P值		0.623		0.505		0.470		0.786
注：其他指接触烫伤

下载: 导出CSV

参考文献(28)

[1]	World Health Organization Burns 2023-10-13 2024-03-09 https://www.who.int/en/news-room/fact-sheets/detail/burns World Health Organization.Burns[EB/OL].(2023-10-13)[2024-03-09]. https://www.who.int/en/news-room/fact-sheets/detail/burns.
[2]	蒋薇,孟承颖,蒋智永,等.2013-2017年安徽某医院1737例小儿烧伤的预后及影响因素分析[J].中华疾病控制杂志,2020,24(1):114-117.DOI: 10.16462/j.cnki.zhjbkz.2020.01.023.
[3]	ChesterSJ,StocktonK,De YoungA,et al.Effectiveness of medical hypnosis for pain reduction and faster wound healing in pediatric acute burn injury: study protocol for a randomized controlled trial[J].Trials,2016,17(1):223.DOI: 10.1186/s13063-016-1346-9.
[4]	中国老年医学学会烧创伤分会.烧伤儿童心理康复治疗全国专家共识(2020版)[J].中华烧伤杂志,2020,36(11):987-992.DOI: 10.3760/cma.j.cn501120-20200623-00321.
[5]	KornhaberR,ChildsC,ClearyM.Experiences of guilt, shame and blame in those affected by burns: a qualitative systematic review[J].Burns,2018,44(5):1026-1039.DOI: 10.1016/j.burns.2017.11.012.
[6]	于庆,肖永强,胡晓燕,等.2723名上海市儿童看护人对小面积烧伤急救知识认知水平的横断面调查与分析[J].中华烧伤杂志,2019,35(3):198-204.DOI: 10.3760/cma.j.issn.1009-2587.2019.03.007.
[7]	NosanovLB,PrindezeNJ,SchneiderDM,et al.Prevalence and risk factors for acute stress disorder and posttraumatic stress disorder after burn injury[J].Am J Surg,2022,223(1):151-156.DOI: 10.1016/j.amjsurg.2021.07.035.
[8]	The National Child Traumatic Stress Network About child trauma 2023-10-19 https://www.nctsn.org/what-is-child-trauma/about-child-trauma The National Child Traumatic Stress Network.About child trauma[EB/OL].[2023-10-19].https://www.nctsn.org/what-is-child-trauma/about-child-trauma.
[9]	SaxeGN,StoddardF,HallE,et al.Pathways to PTSD, part I: children with burns[J].Am J Psychiatry,2005,162(7):1299-1304.DOI: 10.1176/appi.ajp.162.7.1299.
[10]	王卫平.儿科学[M].8版.北京:人民卫生出版社,2013:3-4.
[11]	American Psychiatric Association.精神障碍诊断与统计手册[M].张道龙,译.5版.北京:北京大学出版社,2015:264-266.
[12]	SaxeG,ChawlaN,StoddardF,et al.Child Stress Disorders Checklist: a measure of ASD and PTSD in children[J].J Am Acad Child Adolesc Psychiatry,2003,42(8):972-978.DOI: 10.1097/01.CHI.0000046887.27264.F3.
[13]	孔艳婷,张劲松,帅澜,等.儿童应激障碍检查表中文版的效度、信度[J].中国心理卫生杂志,2014,28(6):452-457.DOI: 10.3969/j.issn.1000-6729.2014.06.010.
[14]	程文凤,赵东旭,申传安,等.14岁以下儿童大面积烧伤的多中心流行病学调查[J].中华医学杂志,2017,97(6):462-467.DOI: 10.3760/cma.j.issn.0376-2491.2017.06.013.
[15]	WatsonP.PTSD as a public mental health priority[J].Curr Psychiatry Rep,2019,21(7):61.DOI: 10.1007/s11920-019-1032-1.
[16]	BattleDE.Diagnostic and statistical manual of mental disorders (DSM)[J].Codas,2013,25(2):191-192.DOI: 10.1590/s2317-17822013000200017.
[17]	HitchcockC,GoodallB,SharplesO,et al.Population prevalence of the posttraumatic stress disorder subtype for young children in nationwide surveys of the British general population and of children in care[J].J Am Acad Child Adolesc Psychiatry,2021,60(10):1278-1287.e3.DOI: 10.1016/j.jaac.2020.12.036.
[18]	席毛毛,雷芳,谢卫国.烧伤患儿心理康复的研究进展[J].中华烧伤杂志,2020,36(6):519-522.DOI: 10.3760/cma.j.cn501120-20190308-00095.
[19]	JordanKC,Di GennaroJL,von Saint André-von Arnim A,et al.Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry[J].Front Pediatr,2022,10:954995.DOI: 10.3389/fped.2022.954995.
[20]	陈朗,周国富,郑倩,等. 1 330例烧伤住院患儿流行病学调查[J].中华烧伤杂志,2018,34(2):111-113.DOI: 10.3760/cma.j.issn.1009-2587.2018.02.010.
[21]	何珊,左泽兰.1946例住院烧伤患儿流行病学调查[J].中华烧伤杂志,2018,34(10):696-700.DOI: 10.3760/cma.j.issn.1009-2587.2018.10.009.
[22]	NieC,WangT,YuH,et al.What're the risk factors for burned children in China? A review[J]. Advances in Social Sciences Research Journal,2018,5(6):295-299.DOI: 10.14738/assrj.56.4746.
[23]	SaxeG,StoddardF,ChawlaN,et al.Risk factors for acute stress disorder in children with burns[J].J Trauma Dissociation,2005,6(2):37-49.DOI: 10.1300/J229v06n02_05.
[24]	De YoungAC,KenardyJA,CobhamVE,et al.Prevalence, comorbidity and course of trauma reactions in young burn-injured children[J].J Child Psychol Psychiatry,2012,53(1):56-63.DOI: 10.1111/j.1469-7610.2011.02431.x.
[25]	De YoungAC,LandoltMA.PTSD in children below the age of 6 years[J].Curr Psychiatry Rep,2018,20(11):97.DOI: 10.1007/s11920-018-0966-z.
[26]	曹秀娟,周莹,虞露艳.烧伤儿童主要照顾者压力对儿童心理应激障碍的影响[J].中国妇幼保健,2022,37(23):4484-4487.DOI: 10.19829/j.zgfybj.issn.1001-4411.2022.23.040.
[27]	HeynSA,BailowitzS,RussellJD,et al.Sex-based variations of prefrontal structure and longitudinal symptoms in pediatric posttraumatic stress disorder[J].Depress Anxiety,2022,39(12):902-912.DOI: 10.1002/da.23296.
[28]	李翠莲,刘红林,刘玲,等.儿童意外伤害的危险因素分析[J].中国中西医结合儿科学,2022,14(1):53-57.DOI: 10.3969/j.issn.16743865.2022.01.014.