急性脑卒中后抑郁的临床观察及其相关因素分析

发布时间：2018-03-17 16:01

本文选题：脑卒中后抑郁　切入点：发生率　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的1、前瞻性研究急性脑卒中患者卒中后抑郁发生率及其临床特点;2、比较急性卒中后抑郁患者与急性卒中后非抑郁患者之间临床资料、实验室检查、影像学检查等相关因素的差异;3、利用Logistic回归分析进一步了解急性脑卒中后抑郁的相关危险因素。方法采用前瞻性、观察性临床研究方法,连续入选2016年4月~2016年9月在宁夏医科大学总医院神经内科住院且符合诊断标准的急性脑卒中(发病7天内)的患者共97例,收集患者的一般资料,包括社会人口学调查、既往病史、实验室指标,颅脑影像学检查等。在患者发病后14d±2d对所有患者采用PHQ-9进行抑郁筛查,将其分成脑卒中后抑郁组和脑卒中后非抑郁组,并对其进行MMSE、NIHSS及ADL评分,比较两组间一般临床资料、实验室检验、影像学检查等相关因素的差异。结果1.一般资料:共入选97例患者,31例患者发生抑郁,男:女=15:16,轻度抑郁29例,中度抑郁2例,无抑郁66例,抑郁发生率31.96%(31/97)。两组间年龄、婚姻状况、受教育程度、职业、超重与肥胖、体质指数、居住状况、经济收入、医保类型、独居、血型、既往史、吸烟、饮酒、过敏史、血脂水平、血糖水平无显著相关(p0.05)。回族患者的PSD发生率高于汉族患者(35.71%VS 31.33%),两组经统计学发现无差异性(p=0.9870.05);PSD组女性16例,发生率44.44%(16/36),男性15例,发生率24.59%(15/61),两组有统计学意义(p=0.0430.05);2个及以上合并症的患者PSD的发生率高于1个合并症的患者,两组差别有统计学意义(p=0.0030.05)。2.脑卒中部位:多次卒中患者的PSD的发生率高于首次卒中患者,但无统计学意义(47.37%VS 28.21%,p=0.1080.05);两组间卒中类型(p=0.369)、病灶数量(p=0.657)、病灶梗死面积(p=1.000)、额叶(p=0.581)、顶叶(p=0.743)、颞叶(p=1.000)、枕叶(p=0.455)、丘脑(p=1.000)、基底节区(p=0.546)、侧脑室旁(p=0.735)、小脑(p=1.000)无明显差异性(p0.05),但左侧大脑半球病变有明显相关性(X2=5.659,p=0.0170.05)。3.发病14d±2d行NIHSS评分PSD组明显高于非PSD组,ADL、MMSE评分PSD组均低于非PSD组,具有显著统计学意义(p0.05)。4、经Logistic回归分析显示PSD与合并症个数、NIHSS评分密切相关。结论1.PSD在2周的发生率为31.96%,以轻度抑郁为主,卒中后抑郁应引起临床重视。2.在女性、合并症多、左侧大脑半球病变的急性脑卒中患者更易发生抑郁。3.神经功能缺损重的患者更易发生PSD。4.合并症个数、NIHSS评分可能为PSD的独立危险因素。
[Abstract]:Objective 1. To study the incidence and clinical characteristics of post-stroke depression in patients with acute stroke. To compare the clinical data and laboratory examination between patients with acute post-stroke depression and those with non-depression after acute stroke. Logistic regression analysis was used to further understand the risk factors of depression after acute stroke. Methods prospective and observational clinical study methods were used. A total of 97 consecutive patients with acute stroke (within 7 days of onset) who were hospitalized in the Department of Neurology, General Hospital of Ningxia Medical University from April 2016 to September 2016 were selected. The general data of the patients were collected, including social demographic survey. All patients were screened for depression with PHQ-9 on day 14 卤2 after onset, and were divided into post-stroke depression group and post-stroke non-depressive group, and their MMSE NIHSS and ADL scores were evaluated. Results 1. General data: a total of 97 patients, 31 patients with depression, male: female 15: 16, mild depression 29 cases, moderate depression 2 cases. 2. Age, marital status, education, occupation, overweight and obesity, body mass index, living condition, income, type of medical insurance, solitary living, blood type, past history, smoking, drinking, The incidence of PSD in Hui nationality patients was higher than that in Han nationality patients (35.71 vs 31.33). There was no statistical difference between the two groups. There were 16 women in the two groups, and the incidence rate was 44.44% 16 / 366,15 males. The incidence of PSD in the two groups was significantly higher than that in the first stroke group. The incidence of PSD in two or more patients was significantly higher than that in the first stroke group, and the difference between the two groups was statistically significant. The incidence of PSD in multiple stroke patients was higher than that in the first stroke group. However, there was no significant difference between the two groups in terms of the type of stroke (p0.369), the number of lesions, the infarct area p1.000, the frontal lobe p0.581m, the parietal lobe p0.743, the temporal lobe p1.000, the occipital lobe p0.455a, the thalamus p1.000, the basal ganglia p0.54646, the lateral ventriculus p0.735, the cerebellum p1.000), but there was no significant difference between the two groups, but there was no significant difference between the two groups. The NIHSS score of PSD group was significantly higher than that of non-#en2# group, and that of PSD group was lower than that of non-#en4# group. Logistic regression analysis showed that PSD was closely related to the number of complications and NIHSS score. Conclusion 1. The incidence of PSD in 2 weeks was 31.966.The incidence of mild depression was mainly mild, and post-stroke depression should cause clinical attention. Patients with acute cerebral apoplexy with left hemisphere lesions were more likely to develop depression, and patients with severe neurological impairment were more likely to develop PSD.4.The number of complications and NIHSS scores might be independent risk factors of PSD.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R749.4

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