脑梗死患者rt-PA静脉溶栓治疗3个月末卒中后抑郁的临床分析

发布时间：2018-05-01 06:26

本文选题：脑梗死 + 静脉溶栓　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:本研究通过收集大连医科大学附属第一医院神经内科脑梗死患者的相关信息,旨在描述脑梗死患者rt-PA静脉溶栓治疗3个月末卒中后抑郁(Post-Stroke Depression,PSD)的发生率及严重程度,分析卒中后抑郁的可能影响因素,进而探讨各影响因素与rt-PA静脉溶栓治疗脑梗死患者出现卒中后抑郁的不同程度之间的关系。方法:选择2016年1月1日至2016年10月31日期间大连医科大学附属第一医院神经内科收治的符合入组标准的脑梗死患者为研究对象,本次研究经随访3个月剔出失访及死亡患者后,入组103例患者,其中男性患者70例,占67.96%,女性患者33例,占32.04%,男女比例2.12:1。按照是否接受rt-PA静脉溶栓治疗分为溶栓组和非溶栓组(对照组),按照自制调查表(自制患者基本信息采集表、自制出院患者随访表)收集患者各项临床资料,记录患者患病3个月末NIHSS(NationalInstitutes of Health Stroke scale)评分、mRS(modified Rankin Scale)评分、HAMD-17(Hamilton Depression Scale)评分。首先根据是否接受溶栓治疗比较两组患者基线资料是否存在差异,再对卒中后抑郁发生率及抑郁严重程度进行分析;探讨脑梗死患者3个月末卒中后抑郁的相关影响因素,进而比较主要影响因素与患者不同抑郁程度之间的关系。使用SPSS19.0软件包建立数据库,采用t检验、卡方检验、秩和检验、单因素分析、多因素条件Logistic回归分析进行数据处理以及统计学分析。结果:1、103例脑梗死患者一般资料的组间比较差异无统计学意义(P0.05)。2、在103例脑梗死患者中,3个月末发生卒中后抑郁患者35例,发生率为33.98%。其中溶栓组3个月末发生卒中后抑郁患者为14例,发生率占103例脑梗死患者的13.59%,占溶栓组患者的25.00%;非溶栓组3个月末发生卒中后抑郁患者为21例,发生率占103例脑梗死患者的20.39%,占非溶栓组患者的44.68%。对溶栓组和非溶栓组3个月末卒中后抑郁的发生率进行比较,结果显示:溶栓组无抑郁的患者占103例脑梗死患者的比例明显高于非溶栓组,非溶栓组发生抑郁的患者占103例脑梗死患者的比例明显高于溶栓组。两组患者的卒中后抑郁程度差异有统计学意义(P=0.031)。3、在选取的可能对脑梗死患者3个月卒中后抑郁产生影响的16项因素中,其中3项因素:护理人员(P=0.017)、3个月末的mRS评分(P=0.004)以及静脉溶栓治疗溶栓(P=0.013)是脑梗死患者3个月末卒中后抑郁的影响因素。4、护理人员对患者发生重度抑郁的影响差异有统计学意义(P=0.002);患者的3个月末的mRS评分对轻度、中度以及重度三种不同程度卒中后抑郁均有影响,差异均有统计学意义(P=0.006,P=0.000,P=0.000);溶栓治疗对患者发生重度抑郁的影响差异有统计学意义(P=0.045)。其中溶栓组中,患者的3个月末的mRS评分对患者轻度、中度以及重度三种不同程度卒中后抑郁均有影响,差异有统计学意义(P=0.004,P=0.000,P=0.024);非溶栓组中,护理人员对患者发生重度抑郁的影响差异有统计学意义(P=0.007);患者的3个月末的mRS评分对轻度、中度以及重度三种不同程度卒中后抑郁均有影响,差异有统计学意义(P=0.019,P=0.002,P=0.006)。结论:1、rt-PA静脉溶栓治疗不仅可以明显减少脑梗死患者3个月末卒中后抑郁的发生,而且还能够明显降低脑梗死患者3个月末卒中后抑郁的严重程度;2、护理人员、3个月末mRS评分和静脉溶栓治疗与脑梗死患者3个月末PSD发生相关;3、不同的护理人员(家属护理/护工护理)与脑梗死患者(特别是非静脉溶栓治疗的脑梗死患者)3个月末重度卒中后抑郁的发生相关;脑梗死患者3个月末神经功能改善情况与其3个月末轻度、中度、重度抑郁的发生相关;脑梗死患者急性期接受溶栓治疗与脑梗死患者3个月末重度卒中后抑郁的发生相关。
[Abstract]:Objective: This study aims to describe the incidence and severity of Post-Stroke Depression (PSD) in patients with cerebral infarction at the end of 3 months of cerebral infarction by collecting the related information of cerebral infarction in the Department of Neurology, the First Affiliated Hospital of Dalian Medical University, and to analyze the possible influencing factors of post stroke depression, and then to discuss the effects of each image. The relationship between sound factors and rt-PA intravenous thrombolytic therapy in the treatment of post-stroke depression in patients with cerebral infarction. Methods: selected patients who were admitted to the Department of Neurology of the First Affiliated Hospital of Dalian Medical University from January 1, 2016 to October 31, 2016 were selected as the subjects of cerebral infarction which were in accordance with the standard of entry group. This study was followed up for 3 months. After the loss of and death, 103 patients were enrolled in the group, of which 70 were male, 67.96% and 33 in women, accounting for 32.04%. 2.12:1. was divided into thrombolytic and non thrombolytic group (control group) according to whether rt-PA intravenous thrombolytic therapy was accepted, according to self-made questionnaire (self-made basic information collection table, homemade follow-up list of discharged patients) NIHSS (NationalInstitutes of Health Stroke scale) score, mRS (modified Rankin Scale) score, HAMD-17 (Hamilton) score were recorded at the end of 3 months of the patient's illness. First, whether there was a difference in baseline data between the two groups according to whether or not to accept thrombolytic therapy, and then the incidence of post stroke depression Analysis of the severity of depression and the related factors of post-stroke depression in patients with cerebral infarction at the end of 3 months, and then comparing the relationship between the main factors and the degree of depression in the patients. Using the SPSS19.0 software package to establish a database, using t test, chi square test, rank test, single factor analysis, and multiple factor conditional Logistic regression Data processing and statistical analysis were carried out. Results: there was no significant difference in the general data between 1103 patients with cerebral infarction (P0.05).2. Among the 103 patients with cerebral infarction, 35 cases of post-stroke depression occurred at the end of 3 months, the incidence of which was 33.98%. in the thrombolytic group and the incidence of post-stroke depression in 14 cases at the end of 3 months of thrombolytic therapy. 13.59% of the 103 patients with cerebral infarction accounted for 25% of the thrombolytic group, and 21 cases of post-stroke depression in the non thrombolytic group at the end of 3 months, accounting for 20.39% of the 103 patients with cerebral infarction, accounting for the incidence of post-stroke depression in the thrombolytic and non thrombolytic groups at the end of 3 months in the non thrombolytic group, and the results showed that the thrombolytic group had no inhibitory effect on the incidence of post-stroke depression at the end of 3 months. The results showed that there was no inhibition in thrombolytic group in the thrombolytic group. The results showed that the thrombolytic group had no inhibition on the incidence of depression after stroke. The results showed that the thrombolytic group had no inhibition on the incidence of depression after stroke. The results showed that the thrombolytic group had no inhibition on the incidence of depression after stroke. The proportion of depressed patients in 103 patients with cerebral infarction was significantly higher than that in non thrombolytic group. The proportion of 103 patients with cerebral infarction in the non thrombolytic group was significantly higher than that in thrombolytic group. The difference of post stroke depression in the two groups was statistically significant (P=0.031).3, and the selection could produce a shadow of post-stroke depression after 3 months of cerebral infarction. Of the 16 factors, 3 factors: the nursing staff (P=0.017), the mRS score at the end of 3 months (P=0.004) and the thrombolytic thrombolytic thrombolysis (P=0.013) were the factors affecting the post-stroke depression of the patients at the end of the cerebral infarction (.4), and the nursing staff had a statistically significant difference in the effect of severe depression (P=0.002), and the mRS at the end of the 3 month of the patient. The scores had significant effects on three different degrees of post-stroke depression in mild, moderate and severe cases (P=0.006, P=0.000, P=0.000), and the difference in the effect of thrombolytic therapy on severe depression was statistically significant (P=0.045). In the thrombolytic group, the patients' mRS scores at the end of 3 months were mild, moderate, and severe. Three different degrees of post-stroke depression had a significant difference (P=0.004, P=0.000, P=0.024); in the non thrombolytic group, the nursing staff had a significant difference in the effect of severe depression (P=0.007), and the mRS score at the end of 3 months had an effect on the mild, moderate and severe post-stroke depression in three different degrees, The difference was statistically significant (P=0.019, P=0.002, P=0.006). Conclusion: 1, rt-PA intravenous thrombolytic therapy can not only significantly reduce the incidence of post-stroke depression in patients with cerebral infarction at the end of 3 months, but also significantly reduce the severity of post-stroke depression in patients with cerebral infarction at the end of 3 months; 2, nursing staff, mRS scores and intravenous thrombolytic therapy at the end of 3 months, and the treatment of thrombolytic therapy at the end of 3 months. Patients with cerebral infarction were associated with PSD at the end of 3 months; 3, different nurses (family care / nursing care) were associated with the occurrence of severe post-stroke depression at the end of 3 months of cerebral infarction (especially in patients with cerebral infarction treated by non intravenous thrombolytic therapy); the improvement of nerve function at the end of 3 months of cerebral infarction was mild, moderate, and severe depression at the end of the month of 3 months. Thrombolytic therapy in patients with cerebral infarction at acute stage is associated with the occurrence of severe stroke depression at the end of 3 months in patients with cerebral infarction.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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