颅脑损伤后精神障碍的相关因素分析

目的 探讨颅脑损伤后精神障碍的相关因素。方法 对42例颅脑损伤伤者的法医学鉴定资料进行回顾性分析,颅脑损伤诊断按照病史资料和颅脑CT/MRI确定;精神障碍按照CCMD-Ⅱ-R、CCMD-3及龚氏修订的韦氏智力量表(WAIS-RC)确定;伤残程度评定根据《道路交通事故受伤人员伤残评定》标准。将所获得的结果,进行统计学分析。结果 精神障碍以脑震荡后综合征居首位(26.2％),其次是遗忘综合征(21.4％)、神经症(16.6％)等。精神障碍以脑伤的低伤残等级多见(Ⅹ级52.4％,Ⅷ级14.3％,Ⅶ级19.0％),但整体差异无显著性意义(P>0.05)。精神病性精神障碍多分布于脑器质性损伤(脑挫裂伤54.8％,脑干损伤16.7％);非精神病性精神障碍多分布于脑功能性损伤,其中脑震荡占21.4％,其差异有高度显著性(P<0.01);智力缺损多见于脑器质性损伤(P<0.05),80.6％分布于脑伤的Ⅹ级、Ⅷ级和Ⅶ级(P<0.01)。结论 颅脑损伤后精神障碍及智力缺损的发生与颅脑损伤的类型、性质有关,与颅脑损伤的严重程度并不平行。

Retrospective analysis of the mental disorders after brain injury

Objective A study on the mental disorders after brain injury by retrospective analysis of 42 forensic clinical medical cases. Method Degree of skull and brain injury were investigated by the clinical history, and CT/MRI while mental disorders by CCMD- Ⅱ -R, CCMD-3 and WAIS-RC. Degree of injury and disability were evaluated according to the "STANDARD OF THE EVALUATION OF INJURY AND DISABILITY IN CASE OF TRAFFIC ACCIDENT". The results were analyzed statistically. Results Clinical history indicated that the mental disorders were occurred in cases of brain contusion syndrome (26.2%), amnestic syndrome (21.4%) and neuroses (16.6%) were occurred. Most mental disorders were resulted from low-grade brain injury which included Grade Ⅹ 52.4% , Grade Ⅷ 14.3% and Grade Ⅶ 19.0% , but there is no significant difference (P>0.05). Psychogenic mental disorders were resulted from organic brain damage, while non-phychogenic mental disorders were found in cases of brain functional in-jury. Among which brain contusion and laceration occupied 54.8% , concussion 21.4% and brain stem in-jury 16.7%. The difference was very significant between the above two types (P<0.01). Most cases of intellectual deficit were resulted from organic brain injury (P<0.05). In 80.6% intellectual deficit cases, the grade of brain injury were grade Ⅹ , Ⅷ and Ⅶ (P<0.01). Conclusion The occurrence of mental disorders and intellectual deficit after brain injury were related mainly to the types and the nature of brain in-jury, but not related to the seriousness of brain injury.