脑卒中患者并发抑郁影响因素研究

Study on the influencing factors of depression in stroke patients

目的脑卒中患者发病后容易并发抑郁,严重影响患者治疗效果。导致脑卒中患者并发抑郁的相关因素较多,本研究探讨影响脑卒中患者并发抑郁的相关因素,对预防和治疗脑卒中抑郁具有重要意义。方法回顾性分析2016-10-01-2018-10-01南阳市中心医院收治的184例脑卒中患者的临床资料,按照汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分将患者分为抑郁组和非抑郁组。采用HAMD评分评价脑卒中患者抑郁情况,评价总分≥8分为抑郁;采用简易精神状况评价量表(mini-mental state examination,MMSE)评价脑卒中患者智力情况;采用Barthel指数评价量表评估脑卒中患者生活能力水平;采用健康状况调查简表(the MOS item short from health survey,SF-36)评价患者生活质量水平。结果抑郁组和非抑郁组MMSE评分对比,差异无统计学意义,t=1.248,P=0.132;抑郁组Barthel评分为(91.24±13.28)分,高于非抑郁组的(63.10±3.14)分,t=2.481,P=0.014;抑郁组SF-36评分为(16.59±2.40)分,低于非抑郁组的(43.28±8.76)分,t=2.284,P=0.032。抑郁组年龄>60岁(χ~2=5.247,P=0.023)、病程>6个月(χ~2=6.373,P=0.014)、婚姻状态已婚(χ~2=6.259,P=0.018)、小学及以下受教育情况(χ~2=5.024,P=0.025)、与子女或者配偶居住(χ~2=4.651,P=0.036)、1000~2000元月收入情况(χ2=5.398,P=0.021)占比高于非抑郁组,差异有统计学意义。多因素分析结果显示,年龄(OR=1.442,95%CI为1.123~1.851,P=0.004)、婚姻状况(OR=3.012,95%CI为1.203~7.541,P=0.018)、受教育情况(OR=1.050,95%CI为1.014~1.091,P=0.013)、居住情况(OR=1.993,95%CI为1.022~3.886,P=0.042)和月收入情况(OR=2.942,95%CI为1.302~6.647,P=0.009)是影响脑卒中患者并发抑郁的独立危险因素。结论年龄、婚姻状况、受教育情况、居住情况及月收入情况均为脑卒中患者并发抑郁的影响因素。

OBJECTIVE Stroke patients are prone to concurrent depression after onset,which seriously affects the treatment effect of patients.There are many related factors leading to depression in stroke patients.This study explores the related factors affecting depression in stroke patients,which is of great significance for the prevention and treatment of stroke depression.METHODS A clinical data of 184 stroke patients who were treated in Nanyang Central Hospital from October 1,2016 to October 1,2018 were retrospectively analyzed.The patients were divided into depression groups and non-depressed groups according to the Hamilton depression scale(HAMD)score.HAMD score was used to evaluate the depression of stroke patients,and the total score>8 was considered depression;Mini-mental state examination(MMSE)was used to evaluate the intelligence of stroke patients;Barthel index was used to evaluate the living ability of stroke patients;and health status survey was used to brief the survey.The MOS item short from health survey(SF-36)was used to evaluate the quality of life of patients.RESULTS There was no statistically significant difference in MMSE score between the depression group and the non-depression group,t=1.248,P=0.132.The Barthel score in the depression group was(91.24±13.28),higher than that in the non-depression group(63.10±3.14),t=2.481,P=0.014.The SF-36 score was(16.59±2.40),lower than that of the non-depressed group(43.28±8.76),t=2.284,P=0.032.The age of depression group was>60 years(χ~2=5.247,P=0.023),the course of disease was>6 months(χ~2=6.373,P=0.014),the marriage status was married(χ~2=6.259,P=0.018),the education situation in primary school and below(χ~2=5.024,P=0.025),the education with children or spouse(χ~2=4.651,P=0.036),the income of 1000~2000 yuan(χ~2=5.398,P=0.021)in depression group was significantly higher than that of non-depression group,and the difference was statistically significant.Multivariate analysis showed that age(OR=1.442,95%CI:1.123-1.851,P=0.004),marital status(OR=3.012,95%CI:1.203-7.541,P=0.018),education(OR=1.050,95%CI:1.014-1.091,P=0.013),residence(OR=1.993,95%CI:1.022-3.886,P=0.042),and monthly income(OR=2.942,95%CI:1.302-6.647,P=0.009)were independent risk factors for depression in patients with stroke.CONCLUSIONS The quality of life and living standard of patients with stroke complicated with depression are lower than those with non-stroke depression.Age,marital status,education,living conditions,and monthly income may affect stroke patients with depression.