【作者】 陈淑霞；

【导师】 赵永辰；

【作者基本信息】 河北大学 ， 中西医结合临床， 2015， 硕士

【摘要】 目的： 通过对卒中后抑郁相关因素进行回顾性分析研究,以明确卒中后抑郁的发生与病灶部位、社会支持及患者自身因素等各项因素的相关性,从而为预防卒中后抑郁的发生、改善卒中患者生活质量、促进患者神经功能恢复等提供流行病学依据。方法： 1.病例资料:388例卒中患者,均是2012年10月至2014年10月河北大学附属医院中西医结合科门诊、住院部及部分社区患者。均符合诊断标准者320例。签署知情同意书后,将所有最终入组的患者进行一般情况资料(如性别、年龄、文化程度等)及专业医学(如影像学资料、病程长短、卒中次数等)资料调查。在患者病情稳定(2周)后采用美国国立卫生院神经功能缺损评分量表(NIH Stroke Scale,NIHSS)、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD-24)对其身体结构与功能损伤、日常生活运动功能以及抑郁严重程度等方面进行综合评定。卒中诊断标准符合第四届全国脑血管病会议诊断标准,且经头颅CT或MRI确诊,并行头颅MRA、头颈CTA或DSA以了解颅内外责任血管情况。以汉密尔顿抑郁量表评分作为抑郁症状的评定标准。总分<8分为无抑郁,≥8分为轻度抑郁,≥17分为中度抑郁,≥24分为重度抑郁。通过使用单因素分析及多元逐步Logistic回归分析对抑郁症状的各项相关因素进行逐一分析。2.入组流程:按患者就诊顺序收集病例388例,其中因病情加重致意识障碍、严重失语症或临床死亡者22例,出院诊断为周围神经病变、后循环缺血或其他者9例,住院期间据化验回报及相关辅助检查得知有严重心肝肾疾病者16例,因梗死灶部位特殊致患者出现幻觉或精神症状者15例,签署知情同意书(见附表5)后,但拒绝调查者6例。最终入组病例320例,其中男性为185例,女性135例,对最终入组病例进行一般情况、病史采集、影像学资料、社会支持量表、汉密尔顿抑郁量表、美国国立卫生院卒中量表等调查。对调查结果进行初步整理后,各相关赋值见附件1、2、3、4。3.研究方法:采用问卷调查的方法对所有符合纳入标准的患者发放问卷。问卷内容包括三方面内容:患者基本情况调查、临床发病信息调查及量表调查三方面内容:一般资料调查包括患者年龄、体重指数、文化程度、职业类型等;医疗信息包括卒中病灶部位、卒中性质、病程长短等;量表调查包括社会支持评定量表、汉密尔顿抑郁量表、美国国立卫生院神经功能缺损评分量表。调查过程中患者须在调查者统一指导语下填写问卷并现场回收,为使减少初始测量数据误差,由两名固定医学人员在尽量避免提示、引导性语言的前提下,据患者综合表现进行评分。将收集资料进行专业汇总并进行统计学处理。结果： 1.本研究共收集388例病例,最终完成调查者320例,其中男性185例,女性135例,因各种原因致脱落病例68例,小于观察病例总数20%。2.在观察320例患者中,卒中后抑郁发病例数为146例,总发病率为45.63%,轻度抑郁者91例(62.33%),中度抑郁者42例(28.77%),重度13例(8.9%)。3.所有的研究因素有性别、年龄、吸烟史、饮酒史、家庭收入、文化程度、职业类型、体重指数、卒中部位、卒中性质、病程长短、卒中次数、危险因素个数、神经功能缺损程度、社会人口支持得分。经单因素分析,性别、文化程度、社会人口支持得分、卒中性质、危险因素个数、神经功能缺损程度这6个因素具有统计学意义。再将上述6个危险因素引入多元逐步回归方程中,性别、文化程度、社会支持程度、危险因素个数、神经功能缺损程度具有统计学意义,卒中性质因95%置信区间过宽而不具临床意义。结论： 卒中后抑郁并非单一因素致病,其相关因素多种多样。本研究发现,男性较女性更易发生抑郁。文化程度、危险因素个数、神经功能缺损程度与卒中后抑郁均存在正相关关系(危险因素),而社会支持程度与卒中后抑郁呈现负相关性(保护因素)。未发现年龄、吸烟史、饮酒史、家庭收入、职业类型、体重指数、卒中部位、病程长短、卒中次数与PSD的发生存在相关性。卒中性质虽进入方程,但因95%置信区间过宽而需要进一步开展大规模临床病例研究前来证实。更多还原

【Abstract】 Object:To evaluate the related factors of post-stroke depression were retrospectively analyzed, to definite the relationship between various factors to clear after stroke occurrence and lesion location, depression and social support and the patient’s own factors, so as to prevent the development of post-stroke depression, improve the quality of life, promote the stroke patients offer epidemiology evidence for the functional recovery of patients etc..Methods:1 Clinical data:388Patients all come from the integration of traditional Chinese and West medicine ward and out-patient clinic of Affiliated Hospital of Hebei University, and some community patients from October, 2012 to October, 2014. 320 patients of 388 patients conform to medicine diagnostic criteria. All of the patients included in the standard will beinvestigate for general information(such as gender, age, culture level, etc.) and professional medical(such as image information, course length, stroke frequency, etc.),after signing of the informed consent. When the patients in stable condition after(2 weeks),we use The US National Institutes of Health Neural Function Defect Stroke Scale and Hamilton Depression Scale to assessment physical structure and function injury, daily life movement function and severity of depression and so on. Stroke diagnosis standards are according to the Fourth National Conference on cerebrovascular diseases diagnostic criteria. And all patients confirmed by skull CT or MRI, head MRA 、head and neck,CTA or DSA to understand the intracranial and extracranial blood vessel. We use Hamilton depression rating scale as the evaluation criteria of depression. The total score < 8 divided into depression, 8-17(excluding17) were divided into mild depression, 17-24(excluding 24) divided into moderate depression, more than 24 divided into severe depression. We use single factor analysis and multiple stepwise regression analysis to analyze the relevant factors on depressive symptoms.2 The group process:According to the order of treatment in patients with 388 Cases, including 22 patients with severe aphasia or aggravation of clinical death induced bydisturbance of consciousness; discharge diagnosis of peripheral neuropathy, posterior circulation ischemia or other in 9 cases;16 cases of hospitalization according to laboratory report and related auxiliary examination that has serious heart liver and kidney diseases; in 15 cases,for infarction of special patients induced by hallucinations or psychiatric symptoms; signing the informed consent(Annex5), but declined to 6 subjects. Finally in 320 cases, including 185 cases of male, female 135 cases, the final into the group of cases is the general situation, history, imaging data, social support scale, Hamilton depression scale, USA NIH stroke scale investigation. The result of the investigation after the initial order, each related assignment is found in Annex1, 2, 3, 4.3 Research methods: By using the method of questionnaire to all patients who meet the inclusion criteria of questionnaire. The contents of the questionnaire include three aspects: the basic situation of the investigation of patients with clinical information, investigation and survey of three aspects: the general information including age, body mass index, education level, occupation and other types of medical information; including stroke lesion location, quality, duration of apoplexy; questionnaire including social support rating scale Hamilton depression scale, the National Institutes of health, America score of neural function defect scale. In the process of investigation to fill in the questionnaire were surveyed and unified guidance language recovery site, in order to reduce the initial error of measured data, provided by two medical personnel to avoid fixed tips, guide language, according to the comprehensive performance score of patients.Data were collected and analyzed statistically for professional summary.Results:1 This study collected 388 Cases, the final completion of the survey in 320 cases, including 185 cases of male, female 135 cases, for various reasons, fall 68 cases, less than the total number of 20% cases observed.2 in the observation of 320 cases of patients, the incidence of post-stroke depression in 146 cases, the total incidence rate was45.63%, 91 cases of mild depression(62.33%), 42 patients with moderate depression(28.77%), 13 severe cases(8.9%).3 All studies factors included sex, age, smoking history, drinking history, family income, culture degree, occupation type, body mass index, population, social support score stroke position, nature of stroke, risk factors, disease duration, number of nerve function defect degree, stroke number. By single factor analysis, sex, culture degree, the degree of social support, the nature of stroke, the number of risk factors, neural function defect degree of the 6 factors with statistical significance. The 6 risk factors into the multiple stepwise regression equation, sex, culture degree, the degree of social support, risk factors with statistical significance number, the degree of neurological deficits, stroke nature because of 95% confidence interval is too wide and not of clinical significance.Conclusion:Treating post-stroke depression is not a single factor, the factors related to various. The study found that, more common in men than in women with post-stroke depression, are positively related with culture degree, the number of risk factors, neural functional defect and post stroke depression(risk factors), and the degree of social support and depression after stroke showed a negative correlation(protective factors). Not found the age, smoking history, drinking history, family income, occupation type, body mass index, stroke position, course of disease, stroke frequency to PSD had significant correlation. Although the stroke properties into the equation, but because the confidence interval width too large,so this need for further large-scale clinical case studies to confirm.更多还原