脑卒中后抑郁、焦虑发生率与影响因素分析

The incidence of post-stroke depression and anxiety and its related factors

目的探讨脑卒中后抑郁、焦虑的发生情况和影响因素,为干预治疗提供参考依据。方法选择2002年3月-2003年3月收治的158例脑卒中非急性期患者,其中脑梗死135例,脑出血23例。采用抑郁自评量表(SDS)、焦虑自评量表(SA S)进行检测,同时进行日常生活活动能力量表(ADL)、画钟测验(CDT)和简易精神状态检查(M M SE)。AD L>26分视为存在生活活动能力障碍,M M SE评分根据患者文化程度的不同有所区别,分值越低,认知功能障碍程度越严重;CDT≤3分为存在认知功能障碍,SDS、SAS总分>50分为抑郁、焦虑状态,>60分,为中度抑郁、焦虑。结果158例脑卒中患者中轻度抑郁17例(10.76%),中、重度抑郁12例(7.60%);轻度焦虑28例(17.72%),抑郁与焦虑并存者21例(13.29%)。57例存在抑郁和焦虑的患者,简易精神状态检查、日常生活活动能力评分和画钟测验存在障碍的比例(57.89%、42.11%、66.67%)明显高于非焦虑、抑郁者(35.64%、29.70%、46.53%)。多因素逐步回归分析表明,卒中后抑郁与患者年龄、性别、患病次数无关,而与卒中后是否存在肢体活动障碍有关,且对患者认知功能有一定影响。结论脑卒中患者在恢复期易发生抑郁、焦虑等精神心理障碍,部分患者可两种状态并存,对患者病死率、生存质量、生活满意度和心理健康等有较大影响,应引起重视。

Objective To study the incidence of depression and anxiety after stroke and analyze its related factors for providing reference to treatment. Methods A total of 158 patients after acute stroke were selected during March 2002 to March 2003. Among them there were 135 cerebral infarction patients and 23 cerebral hemorrhage patients. All patients were assessed with the scale of self-rating depression scale (SDS), self-rating anxiety scale (SAS), activities of daily living scale (ADL), clock draw test (CDT), and mini-mental state examine (MMSE). It is defined as impairment of activity of daily life with ADL > 26, dysfunction of cognation with CDT ≤ 3, MMSE differed from various education level, the lower the score, the severe the cognitive impairment. When SDS or SAS > 50 was considered as mild depresstion and anxiety, and while SDS or SAS > 60 was considered as severe depresstion. Results Among 158 patients, the incidence of post-stroke depression was 36.1%, classified as mild depression (n=17, 10.76%), severe depression (n=12, 7.60%), anxiety (n=28, 17.72%), both depression and anxiety (n=21, 13.29%). The incidence of MMSE, ADL, CDT impairment in 57 patients with depression and anxiety was higher (57.89%, 42.11%, 66.67%) than that in patients without depression and anxiety (35.64%, 29.70%, 46.53%). It was revealed by multiple regression analysis that depression was not correlated with sex, age and the times of stroke, but correlated with the severity of hemiplegia, and it could affect the cognitive function. Conclusion The psychophysiological dysfunction e.g. depression and anxiety frequeutly occurred during recovery in patients with stroke, both depression and anxiety are occurred in some patients. The fatality, survival quality, life satisfactory degree and psychological healthy are influenced in much extent by depression and anxiety.