脑卒中后焦虑及其心理干预的前瞻性对照研究

Effect of Supportive Psychological Intervention on Anxiety after Stroke:A Controlled Prospective Study

目的 :探讨脑卒中后焦虑症状的严重程度及影响因素 ,并评价心理干预的效果。方法 :2 0 6例首次脑卒中的住院病人 ,随机分为心理干预组和对照组 ,进行一系列神经、心理评定 ,分别在病后第三、六、十二个月时随访。结果 :2 0 6例脑卒中病人急性期 (一个月内 )焦虑症状发生率为 18 4% ;三次随访心理干预组焦虑减分率均明显大于对照组 ;多因素分析显示 ,急性期焦虑症状的发生及随访期间的持续存在(SAS减分少 )与心理社会因素 (治疗依从性差、家庭负担重、人均收入少、生活事件多或重、社会支持少、病前健康状况差 )、人口学资料 (女性、年龄较小 )、病情 (神经功能缺损、生活能力差、智能相对完好 )有关。结论 :脑卒中后焦虑症状并不少见 ,其发生以及持续存在不仅与疾病本身有关还与多种病前或病后的心理社会因素有关。心理干预有助于焦虑的减轻。

Objective:To investigate the rate of anxiety after str oke and study the effect of psychological intervention.Method:206 i npatients(male 126,female 80,mean age 63±16)with stroke were divided into inte rvention group(103 cases)and control group(103 cases),which matched by sex a nd age.All subjects were tested with SAS,DNF,MMSE,LES and ADL before interventi o n,3 months,6 months and 12 months later.Results:The rate of anxiety a fter 1 month of stroke in our sample was 18.4%.The reduction rate of SAS was g re ater in intervention group than control at all follow up points.Multi-factorial analysis showed,many factors including female,younger at onset,severity of strok e,poor general physical condition,less compliance with treatment,and other psych o-social factors(heavier family burden,less income,more life events,less social support)were all associated with anxiety after stroke and less reduction rate of SAS at intake and during follow up.Conclusion:Anxiety is a common c omplication after stroke,its occurrence and maintenance were associated with a v ariety of factors including severity of illness and psychosocial factors.Suppor tive psychological intervention can reduce anxiety after stroke.