脑外伤所致精神障碍伤残鉴定时机  

Assessment Time on Mental Disability Due to Brain Damage

作　　者：汤涛[1] 张钦廷[1] 蔡伟雄[1] 陆晓[1] 黄富银[1] 吴家声[1] 汪建君[1] 

机构地区：[1]司法部司法鉴定科学技术研究所上海市法医学重点实验室,上海200063

出　　处：《法医学杂志》2009年第1期27-32,共6页Journal of Forensic Medicine

摘　　要：目的研究脑外伤所致精神障碍伤残相对合理准确的最佳鉴定时机。方法对93例交通事故脑外伤所致精神障碍患者进行伤残鉴定及随访调查,在伤后不同时间段(3、6、9、12月)分别收集患者颅脑影像学、脑电图及详细病史资料,并对患者家属进行调查和对患者进行精神检查及智力量表(Wechsler Intellegence Scale for Adult,WAIS)、社会功能缺陷筛选量表(Social Disability Screening Schedule,SDSS)和日常生活能力量表(Activity of Daily Living Scale,ADL)测验,据此进行诊断及评残。结果ADL、SDSS对不同等级伤残及不同时间段区分良好,整体样本显示患者ADL、SDSS平均值9月与12月无差别,轻度伤残ADL、SDSS平均值6、9、12月无差别,中度伤残ADL、SDSS平均值9月与12月无差别,重度伤残ADL平均值6、9、12月无差别。结论脑外伤所致精神障碍伤残鉴定轻度伤残以伤后6个月评定为宜,中度伤残以伤后9个月评定为宜,重度伤残统计结论显示评残时机为伤后6个月,但综合分析认为重度伤残以伤后9个月评定为宜。Objective To determine the best time for assessing mental disability due to brain damage. Methods Ninety-three mental disabilities due to brain damage in traffic accidents were assessed and their follow-up studies were taken in different period after the brain injury： 3 months, 6 months, 9 months and 12 months. The patients＇ brain imaging, electroencephalogram（EEG） and detailed medical history were collected. Then to interview the patients＇ family members and to assess the patients＇ mental conditions with Wechsler Adult Intelligence Seale（WAIS）, Social Disability Screening Schedule（SDSS）, and Activity of Daily Living Scale （ADL）. Diagnosis and disability assessments were based on all of the above information. Results ADL and SDSS had good distinction between different levels of disability and different time. The overall sample demonstrated that there was no statistically significant difference between patients＇ ADL and SDSS averages in 9 and 12 months. For mild disability, there was no statistically significant difference between ADL and SDSS averages in 6, 9 and 12 months. For moderate disability, there was no statistically significant difference between ADL and SDSS in 9 and 12 months. And there was no statistically significant difference between ADL and SDSS averages in 6, 9 and 12 months for severe disability. Conclusion For mild disability, it is recommended to assess the mental disability 6 months after the injury, for moderate disability, it is 9 months. The statistics data recommended that the best assessment time for severe disability is 6 months after injury. However, our comprehensive analysis concludes that the suitable time is 9 months after injury.

关 键 词：司法精神病学 精神障碍 脑损伤 事故 交通 残疾鉴定 日常生活能力量表 社会功能缺陷筛选量表 

分 类 号：DF795.3[医药卫生—法医学]