血肿特点与脑出血患者卒中后抑郁的关系研究

Relationship between Characteristics of Hematoma and Post-stroke Depression in Patients with Cerebral Hemorrhage

背景目前,血肿特点与脑出血患者卒中后抑郁(PSD)的关系尚未完全明确。目的探讨血肿特点与脑出血患者PSD的关系。方法选取2016年1月—2017年6月哈励逊国际和平医院收治的脑出血患者166例,剔除20例,根据PSD发生情况分为PSD组(n=66)和非PSD组(n=80)。比较两组患者性别、年龄、出血量、吸烟史、合并症(包括高血压、血脂异常、糖尿病)、美国国立卫生研究院卒中量表(NIHSS)评分及血肿部位(包括额叶、顶叶、颞叶、枕叶、基底核区、脑干及小脑),脑出血患者PSD影响因素采用多因素Logistic回归分析。结果 (1)本研究中146例脑出血患者PSD发生率为45.2%,其中轻度抑郁者占57.6%(38/66),中重度抑郁者占42.4%(28/66)。(2)PSD组患者出血量大于非PSD组,NIHSS评分及左侧额叶血肿、左侧颞叶血肿、左侧基底核区血肿发生率高于非PSD组(P<0.05);两组患者男性比例、年龄、有吸烟史者所占比例及高血压、血脂异常、糖尿病、右侧额叶血肿、双侧顶叶血肿、右侧颞叶血肿、双侧枕叶血肿、右侧基底核区血肿、脑干血肿、小脑血肿发生率比较,差异无统计学意义(P>0.05)。(3)多因素Logistic回归分析结果显示,出血量〔OR=2.036,95%CI(1.315,3.149)〕、额叶血肿〔OR=1.732,95%CI(1.241,2.416)〕及颞叶血肿〔OR=1.795,95%CI(1.262,2.555)〕是脑出血患者PSD的独立影响因素(P<0.05)。结论出血量、额叶血肿及颞叶血肿是脑出血患者PSD的独立影响因素,临床应针对出血量大、额叶血肿及颞叶血肿患者给予有针对性的干预措施以降低PSD发生风险。

Background Relationship between characteristics of hematoma and post-stroke depression(PSD)in patients with cerebral hemorrhage has not been fully identified so far.Objective To investigate the relationship between characteristics of hematoma and PSD in patients with cerebral hemorrhage.Methods A total of 166 patients with cerebral hemorrhage were selected in Harrison International Peace Hospital from January 2016 to June 2017,20 cases were excluded,and they were divided into PSD group(n=66)and non-PSD group(n=80)according to the incidence of PSD.Comparison of gender,age,volume of bleeding,smoke history,incidence of combined diseases(including hypertension,dyslipidemia and diabetes),NIHSS score and sites of hematoma(including frontal lobe,parietal lobe,temporal lobe,occipital lobe,basal ganglia area,brainstem and cerebellum)was made between the two groups,and influencing factors of PSD in patients with cerebral hemorrhage was analyzed by multivariate Logistic regression analysis.Results(1)Incidence of PSD was 45.2%in the 146 patients with cerebral hemorrhage in this study,thereinto mild depression accounted for 57.6%(38/66),moderate to severe depression accounted for 42.4%(28/66).(2)Volume of bleeding in PSD group was statistically significantly more than that in non-PSD group,NIHSS score as well as incidence of left frontal lobe hematoma,left temporal lobe hematoma and left basal ganglia area hematoma in PSD group were statistically significantly higher than those in non-PSD group(P<0.05);there was no statistically significant difference in male proportion,age,proportion of patients with smoking history,incidence of hypertension,dyslipidemia,diabetes,right frontal lobe hematoma,bilateral parietal lobe hematoma,right temporal lobe hematoma,bilateral occipital lobe hematoma,right basal ganglia area hematoma,brainstem hematoma or cerebellum hematoma between the two groups(P>0.05).(3)Multivariate Logistic regression analysis results showed that,bleeding volume〔OR=2.036,95%CI(1.315,3.149)〕,frontal lobe hematoma〔OR=1.732,95%CI(1.241,2.416)〕and temporal lobe hematoma〔OR=1.795,95%CI(1.262,2.555)〕were independent influencing factors of PSD in patients with cerebral hemorrhage(P<0.05).Conclusion Volume of bleeding,frontal lobe hematoma and temporal lobe hematoma are independent influencing factors of PSD in patients with cerebral hemorrhage,thus we should carry out targeted treatment for patients with large volume of bleeding,frontal lobe hematoma or temporal lobe hematoma,to reduce the risk of PSD on clinic.