影响重型颅脑损伤患者重返工作的因素分析

Analysis of Factors Affecting sTBI Patients Returning to Work

摘要: 目的：探讨重型颅脑损伤(severe traumatic brain injury, sTBI)后患者重返工作的影响因素。方法：选取2011年至2015年间在某司法鉴定中心就诊的452例sTBI患者为研究对象，通过电话随访sTBI发生1年时是否重返工作，共获得有效反馈346例，将其分为重返工作组(67例)和未重返工作组(279例)，通过查阅鉴定档案的方式获取两组的一般人口学资料和临床症状学资料并进行回顾性分析，探讨可能与sTBI患者重返工作有关的影响因素。结果：在sTBI发生1年时重返工作率为19.4%。其中重返工作率：女性(4.3%)低于男性(23.1%)、有人格改变(7%)低于无人格改变(26.6%)、有情绪障碍(15.1%)低于无情绪障碍(26.8%)，差异均有统计学意义(P < 0.05)。二元Logistic回归分析发现性别(OR = 0.153, P < 0.05, 95% CI 0.046~0.509)、人格改变(OR = 0.195, P < 0.05, 95% CI 0.092~0.415)、情绪障碍(OR = 0.516, P < 0.05, 95% CI 0.291~0.913)是影响sTBI患者重返工作的因素。结论：女性、人格改变、情绪障碍是影响sTBI患者重返工作的危险因素，可对临床因素进行早期识别和有针对性的干预，或许可以帮助患者更好地重返工作岗位。

Abstract: Objective: To explore the influencing factors of patients returning to work after severe traumatic brain injury (sTBI). Methods: A total of 452 patients with sTBI who were treated in a forensic iden-tification center from 2011 to 2015 were selected as the research objects. The patients were fol-lowed up by telephone to see whether they returned to work one year after the occurrence of sTBI. A total of 346 cases received effective feedback. They were divided into a return to work group (67 cases) and a non-return to work group (279 cases). The general demographic data and clinical symptom data of the two groups were obtained by consulting the identification files and analyzed retrospectively to explore the influencing factors that may be related to the return to work of sTBI patients. Results: The rate of returning to work 1 year after sTBI was 19.4%. Among them, the rate of women’s (4.3%) return to work was lower than that of men (23.1%), the rate of return to work with personality changes (7%) was lower than that without personality changes (26.6%), and the rate of return to work with emotional disorders (15.1%) was lower than that without emotional disorders (26.8%). The differences were statistically significant (P < 0.05). Binary Logistic regres-sion analysis showed that gender (OR = 0.153, P < 0.05, 95% CI 0.046~0.509), personality change (OR = 0.195, P < 0.05, 95% CI 0.092~0.415), and emotional disorder (OR = 0.516, P < 0.05, 95% CI 0.291~0.913) were risk factors affecting the return to work of sTBI patients. Conclusion: Female, personality change and emotional disorder are the factors influencing the return of sTBI patients. Early identification and targeted intervention of clinical factors may help patients to better return to work.