摘要
目的:了解急性脑梗死并发脑卒中后抑郁的起病规律及临床特点。方法:以2002-07/2004-08北京市丰台区右外医院收治的颈内动脉系统急性脑梗死患者157例为观察对象。所有患者入院24h内进行神经功能缺损程度评分(总分45分,轻型0～15分;中型16～30分;重型31～45分),然后连续观察6个月,在此期间严密观察患者精神状态的改变,定期应用Zung抑郁自评量表进行筛查。住院期间由主管医师负责协助患者进行筛查,出院后随诊医师负责患者的随访,定期上门协助患者进行筛查,对Zung抑郁自评量表评分≥30分者采用17项版本的汉密顿抑郁量表进行测查(评分8～17分轻度抑郁;18～23分为中度抑郁;≥24分为重度抑郁)。将汉密顿抑郁量表评分≥8分的患者作为抑郁组,其余编入对照组,观察脑卒中后抑郁的发生率,对比两组在性别比例、发病时间、缺血灶的部位及神经功能缺损程度评分方面的差异。结果:按意向处理分析,157例患者均完成了6个月的观察,无失访者。①脑卒中后抑郁发生率22.9%(36/157)。②起病时间为脑卒中后11～40d,平均(22.43±7.2)d。③男性93例中发生抑郁17例(18%),女性64例中发生抑郁19例(30%),女性发病率明显高于男性(χ2=14.53,P<0.05)。④抑郁组神经功能缺损程度评分显著高于对照组(27.54±9.32,18.57±12.46,t=4.31,P<0.05)。⑤病变部位在脑左、右侧分布情况比较两组无差异(P>0.05)。结论:脑卒中后抑郁的发生与性别有关,女性脑卒中后抑郁发生率较男性高,考虑与女性本身的性格因素有关。神经功能缺损程度与脑卒中后抑郁呈正相关,神经功能缺失程度越重,抑郁发生率越高。没有明确证据显示大脑病灶发生在左右半球与脑卒中后抑郁发生率有关。
AIM： To study the onset regularity and clinical characteristics of acute cerebral infarction accompanied by post-stroke depression.METHODS： A total of 157 patients with the acute internal carotid artery cerebral infarction, who were treated in the Fengtai District Youwai Hospital of Beijing City from July 2002 to August 2004, were enrolled and investigated with neurologic deficit score （total score was 0 to 45 points： 0 to 15 as mild; 16 to 30 as moderate; 31 to 45 as severe） within 24 hours after admission, and then they were observed for 6 months. During this period, the changes of their mental status were closely observed, and they were screened periodically with Zung self-rating depression scale. During hospitalization, the physicians-incharge were responsible for the screening of the patients, and the follow-up physicians were in charge of the follow-up of the patientsa fter discharge to the house of the patients; The patients, whose score of Zung self-rating depression scale was≥30, were assessed with the 17-item Hamilton depression scale （8 to 17 points as mild depression;18 to 23 points as moderate depression; ≥ 24 points as severe depression）; And then those with score of Hamilton depression scale≥8 was assigned into the depression group, and the other patients were taken as controls （control group）. The incidence rate of poststroke depression was observed; The differences in the proportion of gender, onset time, location of infarcted area and the neurologic deficit score were compared between the two groups. RESULTS： According to intention-to-treat analysis, all the 157 cases completed the 6-month ohservation, no one lost. ① The incidence rate of post-stroke depression was 22.9% （36/157）. ② The onset time was 11 to 40 days after stroke, the average was （22.43±7.2） days. ③ The incidence rate of post-stroke depression was obviously higher in females than in males [18% （17/93）, 30% （19/64）; x^2=14.53, P 〈 0.05].④ The neurologic deficit score was significantly higher in the depression group than in the control group （27.54±9.32, 18.57±12.46,t=4.31, P 〈 0.05）. ⑤ The distribution of infarcted area in left and right brain was not significantly different between the two groups （P 〉 0.05）.CONCLUSION：The occurrence of post-stroke depression is associated with gender, and the incidence rate is higher in females than in males, it is considered to have correlation with the character factor of females themselves, and neurological dysfunction is positively correlated with post-stroke depression; The severer the degree of neurologicaldysfunction, the higher the incidence rate of depression. The data in this study have no clear evidence to show that the infarcted area in left and right brains is associated with the incidence rate of poststroke depression.
出处
《中国临床康复》
CSCD
北大核心
2005年第20期20-21,共2页
Chinese Journal of Clinical Rehabilitation
