老年卒中患者中重度抑郁障碍相关因素及中医药治疗

Analysis on the Depression Related Factors in Elderly Patients after Stroke and the Effect of Chinese Medicine on Them

目的研究老年卒中患者发生抑郁障碍的相关因素及中医药抗抑郁治疗对缺损神经功能恢复的影响。方法入选老年卒中患者377例,根据其17项汉密尔顿抑郁量表(HAMD17)评分情况分为非抑郁障碍组(116例)和抑郁障碍组(261例),分析和研究其发生抑郁障碍的相关因素。然后将抑郁障碍组261例患者随机分为治疗组(135例)和对照组(126例)。分别给予中医药抗抑郁治疗加卒中治疗和单纯卒中治疗4周,观察其HAMD17、汉密尔顿焦虑量表(HAMA)、睡眠障碍量表(SDRS)、临床神经功能缺损程度评分(NDS)的变化。结果脑出血患者抑郁障碍的发生率为79.78%(71/89),明显高于脑梗死患者的65.97%(190/288,P<0.05);发生在小脑、脑干、大脑半球(额叶)部位的卒中患者比其他部位的患者更容易发生抑郁障碍(P<0.05);中重度神经功能缺损的患者较易发生抑郁障碍。经4周治疗,治疗组的HAMD17、HAMA、SDRS、NDS均较对照组显著改善(P<0.05);治疗组治疗后NDS(19.1±16.3)较治疗前(31.3±14.8)显著下降,神经功能得到明显恢复(P<0.05)。结论卒中的性质、部位、及其神经功能缺损程度与抑郁障碍的发生有密切关系,中医药能显著改善卒中患者的抑郁状态,改善卒中患者的抑郁障碍有利于其神经功能的恢复。

Objective To study the depression related factors in elderly patients after stroke and to explore the effect of Chinese medicine anti-depression treatment for improving neurological function in patients with afterstroke depression.Methods Three hundred and seventy-seven after-stroke elderly patients were sorted,according to their Hamilton Depression Scale-17（HAMD17） scores,to the non-depression group（NDG,116 patients） and the depression group（DG,261 patients）.The depression related factors in them were analysed.Moreover,patients in DG were randomly subassigned to two groups,the 135 patients in the treated group were treated with Chinese medicine and general stroke-treatment,and the 126 patients in the control group were treated only with general stroke-treatment for 4 weeks.HAMD17 scores of neurological deficit（NDS）,scores of sleep dysfunction rating scale（SDRS）,Hamilton anxiety rating scale（HAMA）,and treatment emergent symptom scale（TESS） in them were observed before and after treatment.Results Prevalence rate of depression in patients with cerebral hemorrhage was 79.78%（71/89）,significantly higher than that in patients with cerebral infarction,65.97%（190/288,P0.05）.Patients of stroke with lesion occurred at cerebellum,brain stem,or cerebral hemisphere（frontal lobe） and those with moderate/severe neurological deficit were more liable to suffer from depression.The HAMD17,HAMA,SDRS,and NDS scores in the treated group after treatment were all improved more significantly than in the control group（P0.05）.NDS score reduced in the treated group significantly from 19.1±16.3 before treatment to 31.3±14.8 after treatment,showing the evident recovery of nerve function.Conclusion The occurrence of depression after stroke is closely related with the nature and position of the lesion,as well as the degree of neurological deficit in patients.Chinese medicine could improve the depressive manner effectively and thus to make for recovery of neurological function.