基于ERPs及fNIRS的精神伤残客观评定技术研究

With noticeably increasing number of psychiatric impairment evaluation, more attention should be paid to few objective techniques when assessing psychiatric impairment, which leads to doubts about expert opinions. The assessment of psychiatric impairment should be based on daily life ability, social function and etc., which are influenced by symptoms of patients with mental disorders due to traumatic brain injury. P300, MMN and CNV can reflect the severity of cognitive impairment, affective disorder and personality change, and N2pc is considered to be associated with process of attention allocation and generally, cognitive impairment, affective disorder, personality change and attention dysfunction were common symptoms in mental disorders due to traumatic brain injury. The fNIRS can reveal brain function by change of blood oxygen. Therefore, the current study plans to measure fNIRS and components of ERPs and assess symptoms and function lesion of patients with mental disorders due to traumatic brain injury by function and symptoms rating scale. The current study aims to explore the correlation between ERPs and fNIRS and level of psychiatric impairment. The expected results will provide the evidence for correlation between ERPs and fNIRS and symptoms and function lesion of mental disorders due to traumatic brain injury and applied value of ERPs and fNIRS in the evaluation of psychiatric impairment, which will lead to preliminarily develop the objective evaluation technique of psychiatric impairment.

精神伤残鉴定案例近年来不断上升，但客观评定技术相对匮乏，鉴定意见易被人质疑。精神伤残评定是基于脑外伤所致精神障碍的症状对患者日常生活活动能力、社会功能等造成的影响。研究发现P300、MMN及CNV能反映认知损害、情感障碍及人格改变的严重程度，N2pc能反映注意分配的过程，而认知损害、情感障碍、人格改变、注意障碍等症状是脑外伤所致精神障碍的常见症状；fNIRS能通过血氧变化反映脑功能的情况。因此，本研究拟联合检测fNIRS及多种ERPs成分，应用症状及功能评定量表来评估脑外伤所致精神障碍症状的严重程度及其导致的功能损害程度，探索ERPs及fNIRS与精神伤残等级之间的相关性。预期结果有望发现ERPs及fNIRS与脑外伤所致精神障碍的症状群及其导致的功能损害之间的联系，明确ERPs和fNIRS在精神伤残评定中的应用价值，并以此为基础初步构建精神伤残客观评定技术。

精神伤残鉴定中客观评定技术相对匮乏，鉴定意见易被人质疑。精神伤残评定是基于脑外伤所致精神障碍患者的精神症状对其日常生活能力、社会功能等的影响。.既往研究发现ERPs及fNIRS能反映认知损害、情感障碍、人格改变、注意障碍等症状，而上述症状也是脑外伤所致精神障碍的常见症状。本研究入组脑外伤所致精神障碍患者227例，健康对照164例，运用ERPs、fNIRS、眼动检测技术及神经心理学测试，评估脑外伤所致精神障碍症状的严重程度及其导致的功能损害程度，探索ERPs及fNIRS与精神伤残等级之间的相关性。研究结果显示，脑外伤所致精神障碍患者存在智能减退、人格改变、日常生活能力和社会功能的受损等表现；日常生活活动能力量表可以作为区分轻型精神伤残等级的参考指标，眼动参数可以作为判断被试合作程度潜在的客观评定指标；脑外伤所致精神障碍患者P300波幅降低、潜伏期延长，MMN潜伏期延长，CNV晚期成分波幅降低，CNV面积减小，P300、MMN及CNV的潜伏期和波幅在不同伤残等级中均存在一定的差异，EPRs可作为精神伤残潜在的客观评定技术；脑外伤所致精神障碍患者脑区激活程度更弱，但激活范围更广、更分散，排布不规则，fNIRS可以作为脑外伤所致精神障碍潜在的客观评定技术。ERPs、fNIRS、眼动及神经心理学测试均具有一定的优缺点及适用性，在精神伤残评定过程中，可以根据患者的不同情况，有针对性的选择不同的评定技术为精神伤残评定提供客观指标，增强鉴定意见的科学性、客观性和准确性。