脑卒中后睡眠障碍相关因素分析

Correlative factors of sleep disorder after stroke

目的探讨脑卒中患者睡眠障碍的临床情况及相关影响因素。方法选取山东省东营市胜利油田中心医院神经内科自2005年1月至2010年6月收治的脑卒中患者204例，以匹兹堡睡眠质量指数量表（PSQI）判定是否睡眠障碍，比较不同性别、年龄、脑卒中部位患者的睡眠障碍发生率。通过症状自评量表（SCL．90）比较睡眠障碍和无睡眠障碍患者的身心健康状况，通过汉密尔顿抑郁量表（HAMD）、Barthel指数和美国国立卫生研究院卒中量表（NIHSS）评分比较睡眠障碍和无睡眠障碍患者抑郁、生活能力及神经功能缺损程度的差异。结果本组患者睡眠障碍95例，发生率为46．6％（95／204）。女性患者睡眠障碍发生率较高，差异有统计学意义（P〈0．05）。≥70岁患者睡眠障碍发生率最高（57．6％），其次为〈50岁（41．5％）、50～69岁人群（32．9％），脑卒中发生在皮质下患者的睡眠障碍发生率最高（64．2％），其次为大脑皮质（27．4％）、小脑（4．5％），差异均有统计学意义（P〈0．05）。卒中部位位于左半球患者睡眠障碍发生率明显高于右半球患者，差异有统计学意义（P〈0．05）；与脑卒中后无睡眠障碍患者比较，脑卒中后睡眠障碍患者SCL-909项指标、HAMD评分及NIHSS评分均较高，而Barthel指数较低，差异均有统计学意义（P〈0．05）。结论脑卒中患者睡眠障碍发生率较高，并与性别、年龄、卒中部位有关，可导致抑郁、焦虑、神经功能缺损，生活质量下降，临床治疗过程中应积极做好护理工作。

Objective To explore the clinical features of sleep disorder in patients with stroke and its related factors. Methods Two hundred and four patients with stroke, admitted to our hospital from January 2005 to June 2010, were chosen; Pittsburgh Sleep Quality Index （PSQI） was employed to determine whether these patients had sleep disorder; the prevalences of sleep disorder in patients with different ages, genders and lesions of stroke were compared. Symptom Checklist-90 （SCL-90） questionnaire was used to compare the physical and mental conditions of patients with or without sleep disorder; Hamilton Depression Rating Scales （HAMD）, Barthel index, and National Institutes of Health Stroke Scale （NIHSS） were employed to compare the differences of depression, viability and neurologic impairment in patients with or without sleep disorder. Results The prevalence of sleep disorder was 46.6% （95/204）, and it was higher in female group （53.8% vs 38.8%; Xz=3.851, P=0.033）. Patients aged ≥70 years had the highest rate of sleep disorder （57.6%）, followed by patients aged 〈50 years （41.5%）, and then patients aged between 50 and 69 years showed the lowest rate （32.9%）. The sites of stroke located in the subcortex, cortex, and cerebellum enjoyed their prevalences of 64.2%, 27.4% and 4.5%, respectively. The incidence of sleep disorder in patients with stroke located in the left hemisphere was obviously higher than that in the right hemisphere （X2=7.688, P=-0.008）. The results of 9 indexes of SCL-90, scores of HAMD and N1HSS in patients with sleep disorder were significantly higher than those in patients without sleep disorder, while the Barthel index was in the opposite position with obvious differences （P〈0.05）. Conclusion High prevalence of sleep disorder in patients with stroke is noted, which is related to gender, age of the patients and the sites of stroke, and may lead to depression, anxiety,neurological functional deficit and decrease of life quality. And we should pay more attention to nursing care during all the treatment.