初发脑卒中后抑郁的相关因素研究

发布时间：2018-04-01 04:16

本文选题：卒中后抑郁　切入点：卒中部位　出处：《西南医科大学》2016年硕士论文

【摘要】：目的:探讨初发脑卒中急性期患者卒中后抑郁的相关因素。方法:1.依据为汉米尔顿抑郁量表-17(HAMD-17)选择96例初发脑卒中患者并将其划分为抑郁和非抑郁组。2.根据缺血性卒中患者的牛津郡社区卒中项目(Oxfordshire Community Stroke Projec,OCSP)分型,分析研究各类型的卒中后抑郁(post-stroke depression,PSD)发病情况。3.对全部患者进行美国国立卫生院脑卒中量表(NIHSS评分)和蒙特利尔认知评估量表(Montreal cognitive assessment scale,Mo CA)评分,并比较两组患者的基本信息(主要有性别、年龄、文化程度、性格、近期负性事件、家庭关怀、收入、居住地、卒中类型等一般因素)、脑卒中发病部位、既往病史、病灶个数、NIHSS评分、OCSP分型、同型半胱氨酸、超敏C蛋白以及认知功能进行分析以便对比确定出PSD发生的主要影响因素。4.对所得结果利用SSPS17.0来分析,对计量和计数资料分别利用t和卡方检验法进行检验,P0.05表示结果存在统计学差异。结果:1、本研究选择的研究对象总共有患者96例,利用汉密尔顿抑郁量表对这些患者进行分组,将其分为抑郁组及无抑郁组,人数分别为34和62人。其PSD发生率为35.4%。2、对比两组患者的基本信息如文化程度及卒中类型等因素之间没有统计学意差异(p0.05);而性别、年龄、性格、近期负性事件、家庭成员的支持情况、收入状况以及居住地等两组患者有显著差异(P0.05)。3、通过既往病史的调查研究,抑郁组与非抑郁组在高血压、糖尿病以及合并症等方面存在着极显著性差异(P0.01),而在吸烟史和饮酒史方面无显著差异(P0.05)。4、在病灶部位方面:结果表明左右侧二组之间的PSD发生率无差异(P0.05)。按Starkstein法,并利用脑CT检查方法得知,病灶位于大脑半球前、后侧的PSD发生率存在差异(P0.05)。5、依据病灶发生在皮质、基底节区及侧脑室旁、小脑等部位,并统计对比两组的PSD发病情况。结果表明这些部位两组患者的抑郁发生情况不存在统计学差异(P0.05)。6、在OCSP分型方面:根据统计结果表明前循环梗塞出现抑郁的概率相对其余两组的可能性更高,结果存在统计学差异(p0.05)。7、在病灶个数以及NIHSS评分方面,两组患者均存在显著差异(p0.05)。8、根据统计结果可知,抑郁组其同型半胱氨酸含量要显著高于非抑郁组,且两组具有极显著差异(p0.01),而抑郁组其超敏C蛋白含量也要显著高于非抑郁组,且两组具有显著差异(p0.05)。9、抑郁组Mo CA评分要显著低于非抑郁组,且两组具有极显著差异(p0.01)。结论:1.本研究中脑卒中患者PSD急性期发生率为35.4%,以中轻度为主。2.PSD的发生与脑卒中部位、性格、有无家庭关怀、收入状况以及居住地等一般资料有关。而在病灶个数、NIHSS评分方面、高血压、糖尿病、同型半胱氨酸、超敏C反应蛋白都是PSD的相关因素。3.缺血性卒中OCSP分型中,前循环梗塞患者发生PSD的概率高于后循环的。4.PSD对认知功能有一定的影响。
[Abstract]:Objective: to investigate the related factors of post-stroke depression in patients with acute stroke. Methods: according to Hamilton Depression scale (-17HAMD-17), 96 patients with primary stroke were selected and divided into depression group and non-depression group. 2. Oxfordshire Community Stroke Project OCSP typing for stroke patients in Oxfordshire. To analyze the incidence of post-stroke depression (PSD) in all types of patients. All patients were assessed with the National Institutes of Health Stroke scale (NHS) and Montreal cognitive assessment scale (CA). The basic information of the two groups (sex, age, education, personality, recent negative events, family care, income, residence, type of stroke, etc.), the location of stroke, the history of stroke were compared. The number of lesions was evaluated by NIHSS score: OCSP classification, homocysteine, hypersensitive C protein and cognitive function in order to compare and identify the main factors influencing the occurrence of PSD. The results were analyzed by SSPS17.0. The data of measurement and counting were tested by t and chi-square test respectively. Results there were statistical differences between the two groups. Results: 1. A total of 96 patients were selected in this study. The patients were divided into two groups by Hamilton Depression scale (Hamilton Depression scale). The patients were divided into depression group and non-depression group (34 and 62, respectively). The incidence of PSD was 35.40.2.There was no significant difference in basic information such as education level and stroke type between the two groups, but there was no significant difference in sex, age, personality, and so on. Recent negative events, family members' support, income status and place of residence were significantly different between the two groups (P0.05. 3). According to the investigation of past medical history, depression group and non-depressive group were in hypertension. There were significant differences in diabetes mellitus and complications (P 0.01), but there was no significant difference in smoking history and drinking history (P 0.05. 4). The results showed that there was no difference in the incidence of PSD between the left and the right side of the two groups (P 0.05). According to the Starkstein method, there was no significant difference in the incidence of PSD between the left and the right side, according to the Starkstein method, there was no significant difference in the incidence of PSD between the two groups. The incidence of PSD in the front of the cerebral hemisphere and in the posterior side of the brain was different (P0.05. 5). According to the location of the lesion in the cortex, basal ganglia, lateral ventricle and cerebellum, the lesion was located in the cortex, basal ganglia, paraventricular and cerebellum. The results showed that there was no statistical difference in the incidence of depression between the two groups. In OCSP classification, the probability of depression in patients with anterior circulatory infarction was found according to the statistical results. The other two groups are more likely, Results there was significant difference in the number of lesions and the NIHSS score between the two groups. According to the statistical results, the homocysteine content in the depression group was significantly higher than that in the non-depression group. There was a significant difference between the two groups (P 0.01), while the content of hypersensitive C protein in depression group was significantly higher than that in non-depression group, and there was significant difference between the two groups (P < 0.05). The score of Mo CA in depression group was significantly lower than that in non-depression group. There was significant difference between the two groups (P 0.01). Conclusion: 1. The incidence of acute PSD in patients with middle stroke was 35.4g. 2.The incidence of PSDs was mainly moderate and mild, and the location, character, and family care of the patients with middle cerebral apoplexy. However, hypertension, diabetes, homocysteine, hypersensitive C-reactive protein were all related factors of PSD. 3. In the OCSP classification of ischemic stroke, hypertension, diabetes mellitus, homocysteine and hypersensitive C-reactive protein were related to the general data of PSD. The incidence of PSD in patients with anterior circulatory infarction was higher than that in posterior circulation. 4.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

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