脑卒中后焦虑抑郁的临床分析

发布时间：2018-05-19 12:08

本文选题：脑卒中 + 情绪障碍　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景脑卒中又称脑中风,是指急性发病,症状持续24小时以上或直接导致死亡的局部脑血管疾病。病后不仅有偏瘫、失语、视觉缺损及意识障碍等生理功能受损表现,还可能包括情感、精神等方面的障碍。目的通过研究脑卒中患者焦虑和抑郁情绪障碍现状,分析生活质量指数、认知能力、人际交往能力、家庭亲密度与适应性现状对患者焦虑情绪、抑郁情绪的综合影响,为脑卒中患者情绪关怀和干预提供理论依据。方法采用简单随机抽样的方法依据入选标准,选择于2015年9月至2016年9月在我院神经内科住院的197名脑卒中患者作为观察组;同期依据入选标准选择在我院体检中心体检的197名正常人作为正常对照组(C组),所有入组者均予以焦虑量表(SAS)和抑郁量表(SDS)评分,根据评分结果把观察组分为伴情绪障碍组(A组)和不伴情绪障碍组(B组),并对各组入选者之间不同基本情况(性别、职业、文化程度、家庭年收入、医疗保险、年龄、婚姻状况、家庭关系、医护关系)和生活习惯(吸烟习惯、饮酒习惯、锻炼习惯、饮食规律、睡眠质量)进行分析,同时对脑卒中患者予以日常生活能力、认知能力、人际交往能力、家庭亲密度与适应性评分,并对两亚组之间的各项得分进行比较。结果1、脑卒中伴情绪障碍组(A组)和正常对照组(C组)焦虑SAS量表中除了脸红(t=0.72,P=0.511)、晕厥(t=1.17,P=0.34)、紧张(t=4.76,P=0.18)无显著性差异外(P0.05),不幸预感(t=20.02,P=0.000)、手足无措(t=7.82,P=0.001)、胸闷(t=7.25,P=0.002)、害怕(t=5.29,P=0.004)、烦乱(t=6.88,P=0.000)、发疯感(t=5.34,P=0.000)、发抖(t=10.03,P=0.000)、躯体疼痛(t=12.28,P=0.000)等17项得分均有显著差异,具有统计学意义(P0.05),而脑卒中不伴情绪障碍组(B组)和正常对照组(C组)焦虑SAS量表中不幸预感、胸闷、手足无措、紧张、烦乱、害怕、发疯感、躯体疼痛、发抖等20项得分均无显著性差异,不具有统计学意义(P0.05)。2、脑卒中伴情绪障碍组(A组)和正常对照组(C组)抑郁SDS量表中除了易倦(t=1.32,P=0.19)、晨重晚轻(t=4.76,P=0.18)、体重减轻(t=0.36,P=0.234)无显著性差异外(P0.05),忧郁(t=57.31,P=0.000)、易哭(t=12.66,P=0.000)、睡眠障碍(t=6.07,P=0.000)、食欲减退(t=18.23,P=0.000)、便秘(t=9.83,P=0.003)、心悸(t=13.66,P=0.000)、思考困难(t=9.55,P=0.000)、能力减退(t=12.60,P=0.000)、不安(t=22.85,P=0.000)、绝望(t=22.06,P=0.000)、易激怒(t=5.64,P=0.000)、决断困难(t=5.98,P=0.002)、无用感(t=34.06,P=0.000)、生活空虚感(t=38.78,P=0.000)、无价值感(t=26.26,P=0.000)、兴趣丧失(t=22.98,P=0.000)等均有显著性差异,具有统计学意义(P0.05)。但是脑卒中不伴情绪障碍(B组)和正常对照组(C组)SDS量表中忧郁、晨重晚轻、易哭、睡眠障碍、食欲减退、体重减轻、便秘、心悸、思考困难、能力减退、不安、绝望、易激怒、决断困难、无用感、生活空虚感、无价值感、兴趣丧失等均无明显差异,不具有统计学意义(P0.05)。3、与正常对照组(C组)相比,脑卒中伴情绪障碍组(A组)SAS量表(t=16.88,P=0.000)、SDS量表(t=16.88,P=0.000)得分的差异有统计学意义(均有P0.05),脑卒中伴情绪障碍组(A组)明显高于正常对照组(C组);脑卒中不伴情绪障碍组(B组)和正常对照组(C组)的SAS量表和SDS量表得分均无明显差异,不具有统计学意义(P0.05)。4、与正常对照组(C组)相比,脑卒中伴情绪障碍组(A组)中不同基本情况(性别、家庭年收入、医疗保险、年龄、婚姻状况、家庭关系、医护关系)和生活习惯(吸烟习惯、锻炼习惯、睡眠质量)焦虑情绪发生情况的差异有统计学意义(P0.05)。与正常对照组(C组)相比,脑卒中不伴情绪障碍组(B组)中不同基本情况(性别、职业、文化程度、家庭年收入、医疗保险、年龄、婚姻状况、家庭关系、医护关系)和生活习惯(吸烟习惯、饮酒习惯、锻炼习惯、饮食规律、睡眠质量)焦虑抑郁情绪发生情况的差异不具有统计学意义(P0.05)5、日常生活能力量表得分显示:与不伴情绪障碍组(B组)相比,伴情绪障碍组(A组)日常生活能力量表(ADL)中躯体活动中上厕所(t=67.98,P=0.000)、进食(t=37.40,P=0.000)、穿衣(t=9.20,P=0.000)、洗梳(t=44.95,P=0.000)等6项的得分的差异均具有统计学意义,工具性日常活动中打电话(t=139.28,P=0.000)、购物(t=96.15,P=0.000)、备餐(t=68.47,P=0.000)、做家务(t=64.78,P=0.000)等8项得分的差异均具有统计学意义(P0.05)。6、MoCA量表得分显示:与不伴情绪障碍组(B组)相比,伴情绪障碍组(A组)在MoCA量表总分和八个分量表得分上均有显著性差异(P0.05),MoCA量表总得分不伴情绪障碍组(B组)高于伴情绪障碍组(A组)(t=125.67,P=0.000),其中视空间与执行能力认知不伴情绪障碍组(B组)高于伴情绪障碍组(A组)(t=61.53,P=0.000)(P0.05)。7、人际交往能力量表得分显示:伴情绪障碍组(A组)人际交往能力量表得分均高于临界值,平均得分(184.99±59.86)分。与不伴情绪障碍组(B组)比较,其差异有统计学意义(t=65.44,P=0.000),(P0.05)。8、家庭亲密度与适应性量表得分显示:与不伴情绪障碍组(B组)相比,伴情绪障碍组(A组)在家庭亲密度(t=61.53,P=0.000)与家庭适应性(t=19.41,P=0.000)均有显著性差异(P0.05)。9、与不伴情绪障碍组(B组)相比,伴情绪障碍组(A组)其情绪障碍与生活质量各量表得分的相关性,SAS量表得分、SDS量表得分与ADL量表、MoCA量表、家庭亲密度与适应性量表均呈现出显著的线性相关和线性回归关系。10、日常生活能力、认知能力、人际交际能力、家庭亲密度和适应性与伴情绪障碍组(A组)SAS得分拟合多元线性回归方程有统计学意义(复合相关系数R=0.68,决定系数R2=0.47)。伴情绪障碍组(A组)SDS得分拟合多元线性回归方程也有统计学意义(复合相关系数R=0.59,决定系数R2=0.35)。结论1、性别、文化程度、家庭年收入、医疗保险、年龄、婚姻状况、家庭关系、医护关系、吸烟习惯、饮酒习惯、锻炼习惯、睡眠质量对脑卒中患者焦虑和抑郁情绪均有显著影响。而职业和饮食规律对脑卒中后焦虑抑郁无显著相关。2、日常生活能力、认知能力、人际交际能力、家庭亲密度与适应性对脑卒中患者的焦虑和抑郁情绪均有显著影响。3、脑卒中患者更易出现焦虑、抑郁,而导致脑卒中后焦虑、抑郁的原因繁多。
[Abstract]:Background cerebral apoplexy, also known as cerebral apoplexy, refers to acute onset, symptoms lasting more than 24 hours or local cerebral vascular diseases that lead to death directly. After disease, not only hemiplegia, aphasia, visual impairment and disturbance of consciousness are impaired, but also emotional and mental disorders may also be included. The current situation of depression mood disorder, analysis of quality of life index, cognitive ability, interpersonal communication ability, family intimacy and adaptability status on patients' anxiety and depression, and provide a theoretical basis for the emotional care and intervention of stroke patients. Methods using simple random sampling method based on the selection criteria, selected in September 2015. To September 2016, 197 stroke patients were hospitalized in the neurology department of our hospital as an observation group, and 197 normal people were selected as normal control group (group C) in the physical examination center of our hospital in the same period according to the criteria of admission. All the participants were given the Anxiety Scale (SAS) and the Depression Scale (SDS) score, and the observation group was divided into the accompanying mood according to the score results. The disorder group (group A) and the group without emotional disorder (group B) were analyzed with different basic conditions (sex, occupation, education level, family annual income, medical insurance, age, marital status, family relationship, medical care relationship) and life habits (smoking habits, drinking habits, exercise habits, eating habits, sleep quality) among the participants. Stroke patients were given daily life ability, cognitive ability, interpersonal skills, family intimacy and adaptability scores, and the scores were compared between the two subgroups. Results 1, the anxiety SAS scale of the stroke group (group A) and the normal control group (group C) anxiety (t=0.72, P=0.511), syncope (t=1.17, P=0.34), and tension (t=4). .76, P=0.18) had no significant differences (P0.05), t=20.02 (P=0.000), t=7.82 (P=0.001), chest tightness (t=7.25, P=0.002), fear (t=5.29, P=0.004), distraction, mad feeling, body pain, body pain, and so on, with significant differences, with statistical meaning. Meaning (P0.05), but the 20 scores of unfortunate premonition in the anxiety SAS scale of the cerebral apoplexy group (group B) and the normal control group (group C) anxiety, chest tightness, bewilret, nervousness, distraction, fear, madness, somatic pain, and tremor were not significant, and did not have the overall significance (P0.05).2, the cerebral apoplexy with the emotional disorder group (group A) and the normal control group (C). In the depression SDS scale, in addition to t=1.32 (P=0.19), late morning weight (t=4.76, P=0.18), and weight loss (t=0.36, P=0.234), there was no significant difference (P0.05), melancholy (t=57.31, P=0.000), easy to cry (t=12.66, P=0.000), sleep disorder (0), loss of appetite, constipation, heart palpitations, thinking difficulties. T=9.55 (P=0.000), t=12.60 (P=0.000), t=22.85 (P=0.000), despair (t=22.06, P=0.000), easily irritated (t=5.64, P=0.000), difficult decision (t=5.98, P=0.002), useless sense, life emptiness, loss of value, loss of interest, etc, there are significant differences. There was statistical significance (P0.05). But stroke without emotional disorder (group B) and normal control group (group C) SDS scale was melancholy, morning weight late, easy crying, sleep disorder, loss of appetite, loss of weight, constipation, palpitation, difficulty thinking, loss of ability, unease, unease, irritability, difficulty, sense of futility, sense of vain life, loss of value, loss of interest There was no statistically significant difference (P0.05).3, and compared with the normal control group (group C), the scores of SDS scale (t=16.88, P=0.000) in the stroke group (group A) and the SDS scale (t=16.88, P=0.000) were statistically significant (P0.05), and the stroke group (A group) was significantly higher than that of the normal control group (Group). There was no significant difference between the SAS scale and the SDS scale in the B group and the normal control group (group C), and did not have statistical significance (P0.05).4. Compared with the normal control group (group C), the different basic conditions (sex, annual family income, medical insurance, age, marital status, family relationship, medical care relationship) in the group of emotion disorder (group A) were compared with that of the normal control group (group C). Compared with the normal control group (group C), compared with the normal control group (group B), the different basic conditions (sex, occupation, cultural range, family income, medical insurance, age, marital status, family relationship, medical care) were not associated with the group of emotion disorder (group B). Relationship) and habits (smoking habits, drinking habits, exercise habits, diet rules, sleep quality) were not statistically significant (P0.05) 5, and the daily living ability scale scores showed that the daily living ability scale (ADL) in the group of emotional disorders (group A) was compared with the group (group B) without emotional disorder. T=67.98, P=0.000, t=37.40, P=0.000, t=9.20, P=0.000, t=44.95, P=0.000, and so on were all statistically significant in the 6 scores. The difference between the 8 scores of the instrumental daily activities (t=139.28, P=0.000), shopping (t =96.15), preparing meals, housekeeping, etc. The difference was statistically significant (P0.05).6, and the MoCA scale score showed that there were significant differences in the score of the MoCA scale and the eight subscales in the group of mood disorders (group A) with no emotional disorder group (group B), and the total score of the MoCA scale (group B) was higher than that in the group of mood disorders (A group) (t=125.67, P=0.000). The cognition of visual space and executive ability (group B) was higher than that of the group of emotional disorder (group A) (group A) (t=61.53, P=0.000) (P0.05).7, and the score of interpersonal communication ability scale showed that the score of interpersonal communication ability scale in the group of emotional disorder (group A) was higher than that of the critical value, and the average score was (184.99 + 59.86). Compared with the group without emotional disorder (B group), the difference of the score was poor. The difference was statistically significant (t=65.44, P=0.000), (P0.05).8, and the score of family intimacy and adaptive scale showed that there were significant differences in family cohesion (t=61.53, P=0.000) and family adaptability (t=19.41, P =0.000) in the group of emotional disorders (A group) compared with those without emotional disorder group (group B). The emotional disorder group (group A) had a correlation with the scores of the quality of life, the SAS scale, the SDS scale score and the ADL scale, the MoCA scale, the family intimacy and the adaptive scale, which showed a significant linear and linear regression relationship.10, daily life energy, cognitive ability, interpersonal communication ability, family intimacy and adaptation. The multiple linear regression equation fitted with SAS score in the group of stress and emotional disorder (A group) had statistical significance (compound correlation coefficient R=0.68, decision coefficient R2=0.47). The SDS score fitting multiple linear regression equation with emotional disorder group (A group) was also statistically significant (composite phase R=0.59, determining coefficient R2=0.35). Conclusion 1, sex, educational level, family Annual income, medical insurance, age, marital status, family relationship, medical care relationship, smoking habits, drinking habits, exercise habits, and sleep quality have significant influence on the anxiety and depression of stroke patients. The occupational and dietary rules have no significant correlation with anxiety and depression after stroke.2, daily living ability, cognitive ability and interpersonal communication ability. Stress, family intimacy and adaptability have significant influence on the anxiety and depression of stroke patients, and the patients with stroke are more likely to have anxiety and depression, and cause anxiety after stroke, and there are many causes of depression.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R749

【参考文献】