脑卒中后轻中度抑郁患者症状转归及伴随的日常生活活动能力改变

Recovery of symptoms and the changes of activities of daily life in patients with mild to moderate post-stroke depression

目的:观察脑卒中后抑郁患者抑郁症状的转归及伴随的日常生活活动能力的改变。方法:选择2001-06/2002-04汕头市中心医院神经内科住院的74例脑卒中后抑郁患者,均为汉密顿抑郁量表评分8～35分的轻中度抑郁。入院后即进行汉密顿抑郁量表(24项,三级或五级评分,<8分为无抑郁,>35分为严重抑郁)和Barthel指数评定,评定结束后观察,不进行抗抑郁治疗,1个月后再次评定,对仍有抑郁者进行抗抑郁治疗(氟西汀20或40mg/d,顿服,治疗1个月,同时进行心理治疗),治疗1个月后进行第3次评定。结果:74例患者均进入结果分析。①74例患者初次评定后1个月复查,28例自行缓解(汉密顿抑郁量表<8分),其汉密顿抑郁量表各因子分(除体质量和日夜变化外)均较初次评定降低(P<0.05,0.01)。②1个月后再次评定时,抑郁症状自行缓解者Barthel指数明显高于未缓解者(84.04±8.22,64.68±12.34,P<0.05)。③46例抑郁症状未缓解者经抗抑郁治疗1个月后,汉密顿抑郁量表评分明显降低(21.64±7.58,8.33±1.26,P<0.05),Barthel指数略有增加,无统计学意义(64.68±12.34,70.14±9.32,P>0.05)。结论:部分脑卒中后抑郁患者抑郁症状在急性期可自行缓解,同时伴有日常生活活动能力明显提高。部分脑卒中后抑郁患者抑郁症状不能自行缓解。

AIM:To observe the recovery of depressive symptoms and the changes of the acco mpanied abilities in the activities of daily life in patients with post stroke depression. METHODS:Seventy four patients with mild to moderate post stroke depression, whose scores of Hamilton depressive scale ranged from 8 to 35 points, were selec ted from the Department of Neurology,Shantou Central Hospital from June 2001 to April 2002.All the patients were assessed with Hamilton depressive scale (24 ite ms, scored by 3 or 5 degrees,if the score was lower than 8, it was taken as no d epression, and more than 35 as severe depression) and Barthel index (10 items, a nd 10 points for each item) immediately after admission.No antidepressant treatm ent was given during the observation after evaluation, and the patients were eva luated again after 1 month, and those still had depression received antidepressa nt treatment (20 or 40 fluoxetine per day was taken at one draught) for 1 month, they also received psychological treatment at the same period, then they were ev aluated for the third time 1 month after treatment. RESULTS: All the 74 patients were involved in the analysis of results.①The re sults of the reexamination 1 month after the first evaluation in the 74 cases sh owed that 28 cases self relieved (the score of Hamilton depressive scale was le ss than 8), except body mass and diurnal changes, the scores of other factors in Hamilton depressive scale were decreased as compared with the first evaluation (P< 0.05,0.01);②The results of the reexamination 1 month after the first evalua tion showed that the Barthel index was obviously higher in the patients with sel f relief of depressive symptoms than in those without self relief (84.04±8.22 , 64.68±12.34,P< 0.05);③After the 1 month antidepressant treatment, the score of Hamilton depressive scale was obviously decreased in the 46 patients without self relief of depressive symptoms (21.64±7.58,8.33±1.26,P< 0.05),the Barthe l index was insignificantly increased (64.68±12.34,70.14±9.32,P >0.05). CONCLUSION: The depressive symptoms of some post stroke depression at acute p hase can be self relieved, and accompanied by the obvious improvement of the ab ilities in the activities of daily life.The depressive symptoms of some post st roke depression at acute phase cannot be self relieved, and the antidepressant treatment is effective, but their abilities in the activities of daily life have no obvious improvement.