Analysis of the relationship between acute stress disorder or posttraumatic stress disorder and total burn area in adult burn patients based on brain function detection results
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摘要:
目的 基于脑功能检测结果分析成年烧伤患者急性应激障碍（ASD）或创伤后应激障碍（PTSD）与烧伤总面积的关系。 方法 该研究为横断面调查研究。2024年5—9月,选择武汉大学同仁医院暨武汉市第三医院（以下简称该院）烧伤科收治的121例符合入选标准的成年烧伤患者为调查对象。采用自行设计的一般信息调查表调查所有患者的性别、年龄、烧伤总面积、简明烧伤严重指数、行调查时的伤后时间、吸入性损伤情况、休克期入住重症监护病房（ICU）情况等,采用简明烧伤特定健康量表调查所有患者的生活质量,采用ASD量表（ASDS-5）调查62例伤后3 d~1个月的患者的ASD严重程度并由该院精神科医师对其进行ASD诊断,采用PTSD量表（PCL-5）调查59例伤后1个月以上的患者的PTSD严重程度并同前行PTSD诊断。采用功能性近红外光谱技术检测所有患者的左右侧布洛卡区、左右侧背外侧前额叶、左右侧额极的氧合血红蛋白积分值（以下简称积分值）。根据精神科医师的诊断结果,将伤后3 d~1个月的患者分为ASD阳性组和ASD阴性组并计算ASD患病率,将伤后1个月以上的患者分为PTSD阳性组和PTSD阴性组并计算PTSD患病率,分别比较各组患者的一般信息、生活质量得分、ASDS-5得分、PCL-5得分及以上6个兴趣脑区的积分值。采用Pearson相关分析评估行ASDS-5评分患者的年龄、烧伤总面积、6个兴趣脑区的积分值与ASDS-5得分的相关性,评估行PCL-5评分患者的年龄、烧伤总面积、6个兴趣脑区的积分值与PCL-5得分的相关性。结合单因素分析结果及临床意义,筛选成年烧伤患者发生ASD或PTSD的独立影响因素。 结果 根据ASD诊断结果,62例患者中16例患者纳入ASD阳性组、46例患者纳入ASD阴性组,ASD患病率为25.8%。ASD阳性组和ASD阴性组患者一般信息和生活质量得分比较,差异均无统计学意义（P>0.05）；ASD阳性组患者的ASDS-5得分明显高于ASD阴性组（Z=5.96,P<0.05）。根据PTSD诊断结果,59例患者中22例患者纳入PTSD阳性组、37例患者纳入PTSD阴性组,PTSD患病率为37.3%。与PTSD阴性组比较,PTSD阳性组患者烧伤总面积更大、简明烧伤严重指数和PCL-5得分更高、生活质量得分更低（Z值分别为2.96、2.91、6.40、4.69,P<0.05）、吸入性损伤患者和休克期入住ICU患者更多（χ2值分别为9.94、8.02,P<0.05）。ASD阳性组患者左侧布洛卡区、左侧背外侧前额叶、左侧额极、右侧背外侧前额叶、右侧额极的积分值均明显低于ASD阴性组（Z值分别为2.24、2.90、2.24、2.30、2.40,P<0.05）。PTSD阴性组与PTSD阳性组患者的6个兴趣脑区的积分值比较,差异均无统计学意义（P>0.05）。62例行ASDS-5评分患者的左侧布洛卡区、左侧背外侧前额叶、左侧额极、右侧背外侧前额叶、右侧额极的积分值与ASDS-5得分均呈明显负相关（r值分别为-0.29、-0.37、-0.30、-0.31、-0.29,P<0.05）。59例行PCL-5评分患者的烧伤总面积与PCL-5得分呈明显正相关（r=0.35,P<0.05）。左侧背外侧前额叶的积分值是成年烧伤患者发生ASD的独立影响因素（比值比为0.99,95%置信区间为0.98~1.00,P<0.05）。烧伤总面积是成年烧伤患者发生PTSD的独立影响因素（比值比为1.04,95%置信区间为1.01~1.06,P<0.05）。 结论 成年烧伤患者ASD、PTSD的患病率高,烧伤总面积不是成年烧伤患者发生ASD的独立影响因素,但是发生PTSD的独立影响因素。 -
关键词:
- 烧伤 /
- 应激障碍,创伤性,急性 /
- 功能性神经成像 /
- 烧伤总面积
Abstract:Objective To analyze the relationship between acute stress disorder (ASD) or posttraumatic stress disorder (PTSD) and total burn area in adult burn patients based on brain function detection results. Methods This study was a cross-sectional survey. From May to September in 2024, 121 adult burn patients admitted to the Department of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital (hereinafter referred to as this hospital) who met the inclusion criteria were selected as respondents. A self-made general information questionnaire was used to investigate the following information of all patients, including the gender, age, total burn area, abbreviated burn severity index, post-injury investigation time, inhalation injury, intensive care unit (ICU) admission during the shock stage. The burn specific health scale-brief scale was used to investigate the quality of life of all patients. The ASD scale-5 (ASDS-5) was used to investigate the severity of ASD in 62 patients within 3 days to 1 month after injury, and the diagnosis of ASD was made by the psychiatrists of this hospital. The PTSD checklist-5 (PCL-5) was used to investigate the severity of PTSD in 59 patients more than 1 month after injury, and the diagnosis of PTSD was made as before. The functional near-infrared spectroscopy was employed to measure the oxy-hemoglobin integral values (hereinafter referred to as integral values) of Broca's area on both sides, the dorsolateral prefrontal cortex on both sides, and the frontopolar cortex on both sides for all patients. Based on the diagnosis results from psychiatrists, patients within 3 days to 1 month after injury were divided into ASD-positive group and ASD-negative group and the prevalence of ASD was calculated, while patients more than 1 month after injury were divided into PTSD-positive group and PTSD-negative group and the prevalence of PTSD was calculated. The general information, quality of life scores, ASDS-5 scores, PCL-5 scores, and the integral values of the above 6 brain regions of interest were respectively counted for each group of patients. Pearson correlation analysis was employed to evaluate the correlations between the age, total burn area, integral values of the 6 brain regions of interest and the ASDS-5 scores of patients who underwent ASDS-5 assessment, and the correlations between the age, total burn area, integral values of the 6 brain regions of interest and the PCL-5 scores of patients who underwent PCL-5 assessment were evaluated. Based on the results of univariate analysis and clinical significance, the independent influencing factors for the occurrence of ASD or PTSD in adult burn patients were screened out. Results Based on the ASD diagnosis results, among the 62 patients, 16 patients were included in ASD-positive group and 46 patients were included in ASD-negative group. The prevalence of ASD was 25.8%. There were no statistically significant differences in the general information and quality of life scores between patients in ASD-positive group and ASD-negative group (P>0.05). The ASDS-5 scores of patients in ASD-positive group were significantly higher than those in ASD-negative group (Z=5.96, P<0.05). Based on the PTSD diagnosis results, among the 59 patients, 22 patients were included in PTSD-positive group and 37 patients were included in PTSD-negative group. The prevalence of PTSD was 37.3%. Compared with those in PTSD-negative group, the patients in PTSD-positive group had larger total burn areas, higher abbreviated burn severity indexes and PCL-5 scores, and lower quality of life scores (with Z values of 2.96, 2.91, 6.40, and 4.69, respectively, P<0.05), more patients with inhalation injury, and more ICU admission during shock stage (with χ2 values of 9.94 and 8.02, respectively, P<0.05). The integral values of left Broca's area, left dorsolateral prefrontal cortex, left frontopolar cortex, right dorsolateral prefrontal cortex, and right frontopolar cortex of patients in ASD-positive group were significantly lower than those in ASD-negative group (with Z values of 2.24, 2.90, 2.24, 2.30, and 2.40, respectively, P<0.05). There were no statistically significant differences in the integral values of the 6 brain regions of interest between patients in PTSD-positive group and PTSD-negative group (P>0.05). The integral values of the left Broca's area, left dorsolateral prefrontal cortex, left frontopolar cortex, right dorsolateral prefrontal cortex, and right frontopolar cortex of 62 patients who underwent ASDS-5 assessment were significantly negatively correlated with their ASDS-5 scores (with r values of -0.29, -0.37, -0.30, -0.31, and -0.29, respectively, P<0.05). The total burn area of 59 patients who underwent PCL-5 assessment was significantly positively correlated with their PCL-5 scores (r=0.35, P<0.05). The integral value of the left dorsolateral prefrontal cortex was an independent influencing factor for ASD occurrence in adult burn patients (with odds ratio of 0.99, 95% confidence interval of 0.98-1.00, P<0.05). The total burn area was an independent influencing factor for PTSD occurrence in adult burn patients (with odds ratio of 1.04, 95% confidence interval of 1.01-1.06, P<0.05). Conclusions The prevalence rates of ASD and PTSD are high among adult burn patients. Total burn area is not an independent influencing factor for ASD occurrence, but it is an independent influencing factor for PTSD occurrence in adult burn patients. -
Key words:
- Burns /
- Stress disorders, traumatic, acute /
- Functional neuroimaging /
- Total burn area
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参考文献
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Table 1. ASD阳性组与ASD阴性组成年烧伤患者一般信息和生活质量得分及ASDS-5得分比较
组别 例数 性别（例） 年龄[岁,M（Q1,Q3）] 烧伤类型（例） 婚姻状况（例） 烧伤总面积[%TBSA,M（Q1,Q3）] 男 女 火焰烧伤 热液烫伤 化学烧伤 其他 已婚 未婚 离婚 ASD阳性组 16 11 5 42.5（30.8,53.8） 10 2 2 2 12 4 0 9.0（5.5,21.5） ASD阴性组 46 29 17 44.0（32.8,52.8） 20 16 2 8 35 7 4 13.0（5.0,22.3） 统计量值 χ2=0.17 Z=0.31 χ2=4.51 χ2=2.98 Z=0.56 P值 0.681 0.753 0.212 0.225 0.573 注：ASD为急性应激障碍,ASDS-5为ASDS量表,TBSA为体表总面积,ICU为重症监护病房；其他烧伤类型指电烧伤、热压伤,“—”表示无此项 
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Table 2. PTSD阳性组与PTSD阴性组成年烧伤患者一般信息和生活质量得分及PCL-5得分比较
组别 例数 性别（例） 年龄[岁,M（Q1,Q3）] 烧伤类型（例） 婚姻状况（例） 烧伤总面积[%TBSA,M（Q1,Q3）] 男 女 火焰烧伤 热液烫伤 化学烧伤 其他 已婚 未婚 离婚 PTSD阳性组 22 16 6 38.5（34.3,47.5） 16 2 3 1 16 6 0 73.5（54.0,80.5） PTSD阴性组 37 31 6 43.0（31.5,52.0） 24 4 5 4 31 6 0 39.0（12.0,59.0） 统计量值 χ2=0.47 Z=0.72 χ2=0.87 χ2=0.47 Z=2.96 P值 0.493 0.470 0.833 0.493 0.003 注：PTSD为创伤后应激障碍,PCL-5为PTSD量表,TBSA为体表总面积,ICU为重症监护病房；其他烧伤类型指电烧伤、热压伤
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Table 3. ASD阳性组与ASD阴性组成年烧伤患者的各兴趣脑区氧合血红蛋白积分值比较[M（Q1,Q3）]
组别 例数 左侧布洛卡区 左侧背外侧前额叶 左侧额极 右侧布洛卡区 右侧背外侧前额叶 右侧额极 ASD阳性组 16 57.5（18.8,61.9） -8.0（-70.2,36.1） 24.5（11.2,73.6） 69.4（22.1,131.7） 15.6（-17.0,56.0） 17.0（-26.2,75.0） ASD阴性组 46 80.3（52.9,148.0） 53.4（19.1,124.6） 104.0（30.8,191.5） 89.7（46.3,150.8） 81.7（15.5,119.1） 110.8（25.2,193.8） Z值 2.24 2.90 2.24 1.24 2.30 2.40 P值 0.025 0.004 0.025 0.215 0.021 0.016 注：ASD为急性应激障碍
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Table 4. PTSD阳性组与PTSD阴性组成年烧伤患者的各兴趣脑区氧合血红蛋白的积分值比较[M（Q1,Q3）]
组别 例数 左侧布洛卡区 左侧背外侧前额叶 左侧额极 右侧布洛卡区 右侧背外侧前额叶 右侧额极 PTSD阳性组 22 88.7（35.6,199.3） 43.6（26.8,99.7） 89.2（68.0,195.9） 101.6（41.1,174.7） 34.9（16.4,75.5） 75.6（36.4,181.7） PTSD阴性组 37 87.0（37.5,212.5） 54.2（12.6,104.3） 108.5（33.3,167.0） 75.2（18.6,219.2） 54.4（6.9,99.5） 74.7（30.1,151.6） Z值 0.30 0.20 0.22 0.06 0.53 0.25 P值 0.765 0.840 0.827 0.955 0.599 0.802 注：PTSD为创伤后应激障碍
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Table 5. 62例成年烧伤患者发生急性应激障碍的多因素logistic回归分析结果
自变量 回归系数 比值比 95%置信区间 P值 年龄（岁） -0.036 0.96 0.90~1.02 0.228 性别 -0.119 0.89 0.21~3.69 0.870 左侧背外侧前额叶的氧合血红蛋白积分值 -0.013 0.99 0.98~1.00 0.005 烧伤总面积（%TBSA） <0.001 1.00 0.96~1.05 >0.999 注：TBSA为体表总面积
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Table 6. 59例成年烧伤患者发生创伤后应激障碍的多因素logistic回归分析
自变量 回归系数 比值比 95%置信区间 P值 年龄（岁） -0.019 0.98 0.93~1.04 0.532 性别 1.309 3.70 0.75~18.30 0.108 右侧背外侧前额叶的氧合血红蛋白积分值 -0.005 1.00 0.99~1.00 0.184 烧伤总面积（%TBSA） 0.036 1.04 1.01~1.06 0.002 注：TBSA为体表总面积
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