Article(id=1322168723453104864, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322168329855418548, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.07.023, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1751990400000, receivedDateStr=2025-07-09, revisedDate=1772380800000, revisedDateStr=2026-03-02, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159188378, onlineDateStr=2026-10-28, pubDate=1775750400000, pubDateStr=2026-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159188378, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159188378, creator=13701087609, updateTime=1793159188378, updator=13701087609, issue=Issue{id=1322168329855418548, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='7', pageStart='1057', pageEnd='1240', issueExtLink='null', onlineDate='null', pubDate='1775750400000', pubDateStr='2026-04-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159094536, creator='13701087609', updateTime=1793159094536, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1226, endPage=1231, ext={EN=ArticleExt(id=1322168723658625761, articleId=1322168723453104864, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Research progress on pediatric medical traumatic stress, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

This article reviewed the concept,assessment tools,influencing factors,intervention measures and effects of pediatric medical traumatic stress,and proposed relevant nursing insights to provide reference for reducing the occurrence of pediatric medical traumatic stress.

, authors=Qunfang CHENG, Qianyu CHEN, Yu NI, Lili WANG, Wen ZHENG, Xiaowei PAN, authorsList=Qunfang CHENG, Qianyu CHEN, Yu NI, Lili WANG, Wen ZHENG, Xiaowei PAN, authorCompany=null, correspAuthors=Xiaowei PAN, authorNote=null, correspAuthorsNote=
PAN Xiaowei, E-mail:
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322168725462176482, articleId=1322168723453104864, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=儿童医疗创伤应激的研究进展, columnId=1220689485482873504, journalTitle=护理研究, columnName=科研综述, runingTitle=null, highlight=null, articleAbstract=

从儿童医疗创伤应激的概念、评估工具、影响因素、干预措施及效果等方面进行综述,并提出相关护理启示,以期为降低儿童医疗创伤应激的发生提供参考。

, authors=程群芳, 陈茜煜, 倪育, 王丽丽, 郑文, 潘晓巍*, *, authorsList=程群芳, 陈茜煜, 倪育, 王丽丽, 郑文, 潘晓巍, authorCompany=null, correspAuthors=潘晓巍, authorNote=

程群芳,副主任护师,本科

, correspAuthorsNote=
潘晓巍,E-mail:
PAN Xiaowei, E-mail:
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儿童医疗创伤应激的研究进展
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程群芳 , 陈茜煜 , 倪育 , 王丽丽 , 郑文 , 潘晓巍 *, *
护理研究 | 科研综述 2026,40(7): 1226-1231
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护理研究 |科研综述 2026 , 40 (7) : 1226 -1231
儿童医疗创伤应激的研究进展
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程群芳, 陈茜煜, 倪育, 王丽丽, 郑文, 潘晓巍*, *
作者信息
  • 1扬州大学医学院附属盐城妇幼保健院(盐城市妇幼保健院),江苏 224000
通讯作者:
潘晓巍,E-mail:
PAN Xiaowei, E-mail:
作者简介:

程群芳,副主任护师,本科

Research progress on pediatric medical traumatic stress
Qunfang CHENG, Qianyu CHEN, Yu NI, Lili WANG, Wen ZHENG, Xiaowei PAN
Affiliations
  • 1The Affiliated Yancheng Maternity & Child Health Hospital of Yangzhou University Medical School, Jiangsu 224000 China
  • Corresponding Author:
    PAN Xiaowei, E-mail:
出版时间: 2026-04-10 doi: 10.12102/j.issn.1009-6493.2026.07.023
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从儿童医疗创伤应激的概念、评估工具、影响因素、干预措施及效果等方面进行综述,并提出相关护理启示,以期为降低儿童医疗创伤应激的发生提供参考。

儿童  /  医疗创伤应激  /  影响因素  /  综述

This article reviewed the concept,assessment tools,influencing factors,intervention measures and effects of pediatric medical traumatic stress,and proposed relevant nursing insights to provide reference for reducing the occurrence of pediatric medical traumatic stress.

children  /  medical traumatic stress  /  influencing factors  /  review
程群芳, 陈茜煜, 倪育, 王丽丽, 郑文, 潘晓巍. 儿童医疗创伤应激的研究进展. 护理研究, 2026 , 40 (7) : 1226 -1231 . DOI: 10.12102/j.issn.1009-6493.2026.07.023
Qunfang CHENG, Qianyu CHEN, Yu NI, Lili WANG, Wen ZHENG, Xiaowei PAN. Research progress on pediatric medical traumatic stress[J]. Chinese Nursing Research, 2026 , 40 (7) : 1226 -1231 . DOI: 10.12102/j.issn.1009-6493.2026.07.023
儿童医疗创伤应激(pediatric medical traumatic stress,PMTS)是指儿童在接受医疗干预或经历医疗事件后出现的心理创伤反应,可能表现为焦虑、恐惧、回避行为等症状[1]。儿童医疗创伤应激患病率逐年上升,尤其是在经历重大医疗事件(如手术、重症监护)的儿童中更为显著,经历医疗创伤事件后儿童第1个月医疗创伤应激的患病率为7.0%~29.0%,6个月后为10.0%,3年后为2.4%[2],对儿童的日常生活和学习及其成年后的心理健康产生长期影响[3]。随着医疗技术的进步和对儿童心理健康问题的关注,儿童医疗创伤应激的研究逐渐成为医学和心理学领域的热点。国外学者在儿童医疗创伤应激的流行病学、神经生物学机制及干预策略方面取得了显著成果[4],但国内相关研究尚处于起步阶段,儿童医疗创伤应激的研究对于改善儿童医疗体验、提高治疗效果、增强心理健康等方面具有重要意义。因此,本研究对儿童医疗创伤应激的概念、影响因素、评估工具、干预措施及效果进行综述,并提出相关启示,旨在为临床降低儿童医疗创伤应激提供参考。
近年来,儿童心理健康问题日益受到关注,尤其是创伤后应激障碍(post-traumatic stress disorder,PTSD)在儿童群体中的发病率逐年上升,约为50%[5]。创伤后应激障碍是一种精神障碍,通常发生在个体经历或目睹了创伤性事件(如战争、自然灾害、严重事故、暴力犯罪、性侵害、医疗事件等)之后可能出现的严重心理健康问题,表现为创伤记忆的反复重现、回避行为和高警觉等症状[6],这些事件可能对个体的生命或身体完整性构成严重威胁,导致其心理和情感上产生强烈反应[7]。儿童医疗创伤应激作为创伤后应激障碍的一种特殊类型[8],是指儿童在接受医疗干预或经历医疗事件后出现的心理创伤反应,多发生在创伤事件后的6个月内,只有一小部分在发病后几个月内消退,是儿童医疗创伤应激在出院后6个月内患病率高的原因[9],主要表现为焦虑、恐惧、回避行为等症状,如反复出现与创伤相关的记忆、梦境或闪回,避免与创伤相关的情境、话题或活动,出现易怒、注意力难以集中、过度警觉等表现,对他人疏远、情感反应减弱等,儿童医疗创伤应激不仅影响患儿的日常生活和学习,还可能对患儿成年后的心理健康产生长期影响。
儿童创伤问卷是用于评估儿童期创伤经历的自评量表,包含情感虐待、身体虐待、性虐待、情感忽视和身体忽视5个维度,共28个条目,每个条目采用Likert 5级评分法,“从不”计1分,“总是”计5分,总分28~140分[10]。Arabshahi等[11]采用该量表对320名儿童进行调查,结果显示,童年期创伤(如情感忽视)对疾病复发有显著影响,国内尚未检索到该量表在儿童医疗创伤应激群体中的应用。该量表适用于不同文化背景的儿童和青少年,条目简洁,易于实施和评分,具有良好的信度和效度,但涵盖的创伤类型较少,无法全面评估多种不良经历。
不良童年经历国际问卷于2019年由世界卫生组织(WHO)开发[12],旨在建立一个全球不良童年经历监测框架,以评估不良童年经历的全球健康负担,包含情绪虐待、身体虐待、性虐待、家庭暴力、物质成瘾家庭成员、精神疾病家庭成员、父母离异或死亡、情感忽视、身体忽视、霸凌、社区暴力和集体暴力等13个类别的创伤经历,涵盖更广泛的不良童年经历,能够全面评估儿童的创伤暴露情况,但条目较多,实施和评分较为复杂,不适用于低龄儿童。
儿童创伤后应激障碍调查表是一种结构化访谈工具,包含再体验、回避、高警觉和情感麻木等多个维度,其条目设计基于《精神障碍诊断与统计手册(第5版)》(DSM-5)中创伤后应激障碍的诊断标准,适用于6~18岁的儿童和青少年,儿童创伤后应激障碍调查表具有良好的信度和效度,其优势在于能够通过专业人员的引导,深入了解儿童的创伤经历和症状表现,有效评估儿童在医疗创伤后的应激反应,适用于临床诊断,儿童创伤后应激障碍调查表评分较高的儿童在经历医疗创伤后有15.9%更容易发展为创伤后应激障碍,因此可预测创伤后应激障碍的风险[13]。
儿童创伤后反应问卷主要用于评估儿童在创伤事件后的情绪反应,该量表包括闯入性症状、回避行为和警觉性增高症状3个维度,共13个条目,采用Likert 4级评分法,“从不”计0分,“很少”计1分,“有时”计3分,“经常”计5分,所有条目相加的总分即为患儿儿童创伤后反应问卷量表总分,为0~65分,总分≥30分表明有创伤后应激症状的风险[14]。该问卷条目少,易于儿童理解和填写,适用于大规模筛查,以帮助识别需要干预的高风险儿童,但儿童创伤后反应问卷主要用于初步筛查,不能替代临床诊断,适用于6岁及以上儿童,对更小年龄段的儿童可能不适用。Lau等[15]研究显示,在我国儿童青少年群体中,儿童创伤后反应问卷及各维度的Cronbach's α系数为0.74~0.85。
侵入性医疗操作(如手术、插管、注射等)是儿童发生儿童医疗创伤应激的危险因素。Ben-Ari等[16]一项针对152例1~6岁的住院儿童调查显示,侵入性操作会引发儿童的恐惧,增加儿童医疗创伤应激的发生风险,降低儿童疾病治疗的依从性,减缓儿童康复进程[17]。
医疗环境的不适感,如对医院环境的陌生感、噪声、光线以及医疗设备的视觉刺激可能加剧儿童的焦虑和不安[18]。
医疗事件的突发性与严重性与儿童医疗创伤应激发生显著相关,急诊抢救、重症监护等突发且严重的医疗事件更容易导致儿童产生创伤反应[19],12%~46%的儿童在急诊抢救后被诊断为儿童医疗创伤应激,高于癌症(10.0%)等其他慢性病[20]。
Annunziato等[21]研究显示,医护人员缺乏与儿童的有效沟通,或使用过于专业或冷漠的语言,可能增加儿童的恐惧感。Alisic等[22]一项全球调查报告表明,在急诊科仅45%的医护人员知晓儿童医疗创伤应激,对于儿童医疗创伤应激的早期识别、转介和干预仍存在不足,在儿童医疗创伤应激发生后不能及时给予干预,25.9%的儿童出现行为问题,而干预组中仅2.3%的患儿出现行为问题[23]。
女童的儿童医疗创伤应激发病率为男童的2倍,且女童更容易出现疾病的慢性化,这可能与男女海马体的结构差异有关[24]。
低龄儿童由于认知功能有限,可能无法理解医疗操作的目的,容易产生恐惧和误解,青少年则可能因对身体形象的关注而对医疗操作产生更强的抵触情绪[25]。
有既往创伤经历(如虐待、事故等)的儿童更容易在医疗环境中触发创伤反应[26]。
性格内向、情绪敏感的儿童可能更难以应对医疗压力,而外向且适应能力强的儿童则可能表现出更强的韧性[27]。
已有焦虑、抑郁或其他心理健康问题的儿童更容易发生儿童医疗创伤应激[28]。
疼痛管理不足,如医疗过程中疼痛管理不当可能加剧儿童的负面体验,增加儿童医疗创伤应激的风险[29]。
家庭成员的情感支持和陪伴能够降低儿童在医疗环境中的焦虑感,相反,家庭支持不足可能加剧儿童的创伤反应[30];Yagiela等[31]研究显示,儿童医疗创伤应激的程度与父母所经历的创伤后应激障碍症状的严重程度相关。O'Toole等[32]一项横断面调查研究显示,患儿出院后3个月,84%的父母仍然表现出创伤后应激障碍的症状,父母在医疗事件中的焦虑、恐惧或无助情绪可能传递给儿童,影响其心理状态,从而导致儿童医疗创伤应激的发生率较高。
文化程度低且有宗教信仰的父母倾向求助神而不是专业的心理医护人员,在一定程度上影响了对疾病的认知,焦虑、抑郁的发生率较高[33]。
Ridings等[34]一项针对252名儿童的调查显示,经济困难的家庭可能无法为儿童提供及时的医疗和心理支持,且居住地在城乡对就医的可及性也存在差异,影响父母寻求医疗帮助的积极性,增加患儿儿童医疗创伤应激的风险。
缺乏来自学校、社区等社会支持网络的帮助,儿童对医疗信息的理解不足或误解可能导致不必要的恐惧和焦虑,可能使儿童在医疗事件后难以恢复,从而出现儿童医疗创伤应激症状[35]。
认知行为疗法是儿童医疗创伤应激干预的核心方法之一,旨在通过改变儿童的认知模式和行为反应缓解症状,通过减少儿童医疗创伤应激症状,发展积极的应对技能,增加个人的控制感和保持良好情绪状态[36]。一项针对210名儿童进行干预治疗的研究结果显示,认知行为疗法可改善儿童的创伤症状,提升儿童的自我保护能力,缓解儿童抑郁、焦虑等症状[37]。认知行为疗法主要包括暴露疗法、认知重构和应激免疫训练[38]。
通过逐步暴露于创伤相关的情境或记忆,帮助儿童减少对创伤的恐惧和回避行为。
认知重构旨在帮助儿童识别和修正与创伤相关的负面思维,建立积极的认知模式,治疗师可以引导儿童将“医疗过程很可怕”的认知调整为“医疗是为了帮助我恢复健康”。
通过模拟情境训练,增强儿童应对未来潜在创伤的能力,治疗师可以设计角色扮演活动,帮助儿童学习如何在医疗过程中表达需求和情绪,从而减少无助感和焦虑。
认知行为疗法具有明确的结构和步骤,易于标准化和推广、注重认知重建,通过改变负面认知,帮助儿童建立积极应对方式,预防复发,认知行为疗法的长期疗效较好,能有效降低儿童医疗创伤应激复发率,但认知行为疗法通常需要干预多次(12~20次)才能见效,对儿童认知能力要求高,需要儿童具备一定的认知和理解能力,不适合低龄儿童。
眼动脱敏与再加工疗法作为一种有效的心理治疗方法,近年来在儿童医疗创伤应激的干预中得到了广泛应用[39]。眼动脱敏与再加工疗法不需要儿童口头揭露创伤经历的细节,要求儿童双目睁开,眼睛跟着治疗者的手指方向朝两侧快速移动,与此同时要求儿童想象看到创伤时的情景,激活大脑的适应性信息处理系统,帮助儿童重新加工创伤记忆,将其转化为适应性解决方式,眼动脱敏与再加工疗法通过松动大脑中被“困住”的创伤记忆,帮助儿童区分过去与现在,减轻创伤对当前生活的影响,从而促进情绪的平复和转化。研究表明,眼动脱敏与再加工疗法能显著减少儿童医疗创伤应激的核心症状,如侵入性回忆、回避行为和警觉性增高,经过眼动脱敏与再加工疗法治疗后,儿童的创伤症状显著减轻,脑部扫描结果显示前额叶和前扣带回的活跃度显著提升,眼动脱敏与再加工疗法还能改善儿童的社会功能和学业表现,通过认知重建,儿童能够更好地理解创伤事件的意义,从而恢复对日常生活的信心;眼动脱敏与再加工疗法适用于各年龄段儿童,尤其适合语言表达能力有限的低龄儿童;治疗过程相对温和,副作用较少,但治疗质量依赖治疗师水平,需要经过专业培训的治疗师操作[40]。
游戏疗法是指通过游戏活动帮助儿童表达情感、处理创伤,包括沙盘游戏、角色扮演、玩具游戏等,适用各年龄段儿童,尤其适合语言表达能力有限的低龄儿童[41]。通过为儿童提供安全的空间,让儿童在虚拟情境中掌控局面,自由表达情感和经历,释放恐惧、焦虑等情绪,增强应对能力。Jones等[42]对5~10岁儿童游戏的干预研究显示,游戏疗法能有效缓解手术儿童术前焦虑,减少患儿术后应激障碍的发生,促进儿童的心理发展,增强了患儿自我认知和情绪调节的能力,降低了患儿治疗抵触情绪。但游戏疗法通常需要较长时间才能见效,可能不适合需要快速缓解症状的儿童;对治疗师要求较高,需要治疗师具备专业的游戏治疗技能和经验,治疗质量依赖治疗师水平。
近年来,无创物理治疗方法[如经颅直流电刺激(tDCS)和经颅磁刺激(TMS)]逐渐成为儿童医疗创伤应激干预的研究热点。经颅直流电刺激是一种无创、耐受性良好的技术,副作用较少,设备相对简单,操作方便,成本较低,主要通过电极向大脑特定区域施加微弱直流电,调节神经元兴奋性,从而影响脑功能[43]。经颅磁刺激是一种无创技术,可以精准地刺激大脑特定区域,疗效相对较快,利用磁场脉冲无创地刺激大脑特定区域,调节神经元活动,从而影响脑功能,但此设备价格昂贵、操作复杂[44]。经颅直流电刺激和经颅磁刺激在成年人抑郁症、焦虑症等精神疾病治疗中展现出潜力,但针对儿童医疗创伤应激的研究尚处于起步阶段,初步结果显示其对缓解焦虑、抑郁症状可能有效[45],可用来治疗儿童医疗创伤应激的伴随症状,如焦虑、抑郁等。未来应开展更多高质量的儿童临床研究,评估经颅直流电刺激和经颅磁刺激对儿童医疗创伤应激的疗效和安全性;进一步探索经颅直流电刺激和经颅磁刺激的作用机制,优化刺激参数,提高治疗效果;开发适合儿童使用的经颅直流电刺激和经颅磁刺激设备,提高治疗的可行性和可接受性。
除了无创物理疗法,其他物理疗法也逐渐成为儿童医疗创伤应激干预的研究方向。
运动疗法包括有氧运动、力量训练、平衡训练等,帮助儿童改善身体功能,缓解焦虑和抑郁情绪[46]。
放松训练包括渐进性肌肉放松、深呼吸练习、冥想等,帮助儿童放松身心,减轻压力[47]。
感觉统合训练通过提供各种感觉刺激,改善儿童的运动能力、平衡能力和协调能力,并整合感觉信息,改善情绪调节和进行行为控制,帮助儿童恢复日常生活能力,提高生活质量[48]。
药物治疗作为儿童医疗创伤应激干预的重要手段之一,近年来取得了一定进展,主要药物有抗抑郁药[选择性5-羟色胺再摄取抑制剂(SSRIs)、5-羟色胺和去甲肾上腺素再摄取抑制剂]、抗焦虑药(苯二氮䓬类药、非苯二氮䓬类药物)、其他药物(如抗惊厥药、非典型抗精神病药)等[49]。其作用机制主要是调节神经递质,改善情绪和焦虑症状,同时稳定情绪,控制冲动行为,药物治疗总体安全性良好,但需注意个体差异和潜在副作用,如胃肠道反应、嗜睡等[50]。未来可根据患儿的年龄、症状、共病情况等因素制定个性化药物治疗方案,进行长期随访研究评估药物的长期疗效和安全性;研发更具靶向性、副作用更少的新型药物。
准确评估儿童医疗创伤应激是诊断和干预的基础,而评估工具的选择和应用直接影响研究结果的可靠性和有效性,目前的评估工具对低龄儿童医疗创伤应激的评估尚存在不足。因此,未来应针对低龄儿童,开发基于游戏或绘画的评估工具,以更直观地反映其创伤经历和情绪状态;通过结合生理指标(如心率变异性、皮质醇水平)与心理评估工具,提高评估的客观性和准确性;利用人工智能技术开发智能评估系统,能够自动分析儿童的语言、行为和生理数据,提供更高效的评估方案,深入挖掘影响因素。
目前,我国在识别和确保儿童发生医疗创伤应激获得适当支持的研究尚少,医院、家庭、学校对儿童医疗创伤应激的认知有待提升,对儿童医疗创伤应激关注度低,未能及时、准确地进行筛查及干预,发生儿童医疗创伤应激的风险较高。建议医院成立多学科团队,完善医疗支持体系,为预防和经历医疗创伤的儿童提供及时的心理干预;学校应将心理健康教育纳入学校课程,加强儿童心理健康教育;医院、家庭、学校也应充分合作,组织开展相关专题培训,提高儿童和家长对医疗创伤应激的认知。
目前,国内外关于儿童医疗创伤应激的预防干预措施相关研究较少,建议研究人员结合心理学、神经科学和医学等多学科力量,进行跨学科合作,深入探讨儿童医疗创伤应激的机制;根据儿童的症状特点和发展阶段,制定个性化的干预方案,并开展高质量的随机对照试验,验证干预方案的有效性;追踪儿童医疗创伤应激症状的长期演变规律,为干预策略的优化提供依据。
本研究概述了儿童医疗创伤应激的概念、类别、评估工具、影响因素、干预措施及效果,结果显示,儿童医疗创伤应激受自身、家庭、社会等多因素影响,且我国在儿童医疗创伤应激评估工具和精准干预方面的研究尚存在不足。建议研究者深入探索儿童医疗创伤应激的相关因素和机制,进一步探索数字疗法和人工智能在儿童医疗创伤应激治疗中的应用,结合心理学、神经科学和医学的多学科协作,开发个性化治疗方案,建立长期随访机制,评估不同治疗方法的远期疗效,为临床降低儿童医疗创伤应激的发生提供科学依据。

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2026年第40卷第7期
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doi: 10.12102/j.issn.1009-6493.2026.07.023
  • 接收时间:2025-07-09
  • 首发时间:2026-10-28
  • 出版时间:2026-04-10
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  • 收稿日期:2025-07-09
  • 修回日期:2026-03-02
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    1扬州大学医学院附属盐城妇幼保健院(盐城市妇幼保健院),江苏 224000

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潘晓巍,E-mail:
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