初发脑卒中后抑郁各时期的患病情况及相关因素分析

Prevalence and related factors of post-stroke depression

目的分析初发脑卒中后抑郁(PSD)各时期患病情况及相关因素。方法选择嘉兴市第二医院收治的64例初发脑卒中患者,分别在入院1、3、6及12个月时应用汉密尔顿抑郁量表(HAMD)、日常生活能力评定量表(ADL)、社会支持评定量表(SSRS)、神经功能缺损程度评分量表及艾森克人格问卷简式量表中国版(EPQ-RSC)对患者进行评定,统计PSD在各时间点发病率及相关因素分析。结果卒中后抑郁在1、3、6、12个月时PSD的发病率分别为18.75%、29.03%、37.70%、31.03%;卒中后1、3、6个月时PSD者女性及内向性格占比均显著高于非PSD者(P<0.05),且卒中后3、6、12个月时PSD者日常生活能力评分、社会支持评分显著低于非PSD者,而神经功能缺损评分显著高于非PSD者,比较差异均有统计学意义(P<0.05);对各高危因素进行Logistic回归性分析显示卒中后1个月时PSD的发生率与内向性格及女性有关联性(P<0.05);3个月时PSD的发生与女性、日常生活能力、社会支持及神经功能缺损有关(P<0.05);6个月及12个月时,PSD的发生与日常生活能力、社会支持及神经功能缺损有关(P<0.05)。结论对于脑卒中患者而言,抑郁的发病率较高,在临床诊疗中,早期应密切关注女性、性格内向者,中、晚期应加强对低水平日常生活能力者及社会支持者和伴有严重神经功能缺损者的监护,提前预防,尽早治疗,以降低本病发生率。

Objective To analyze the prevalence and related factors of post-stroke depression（ PSD） in each period of stroke. Methods Total 64 cases of first stroke were selected in our hospital. The Hamilton Depression Rating Scale（ HAMD）,daily life ability Rating Scale（ ADL）,social support rating scale（ SSRS）,neurological function impairment scale and Eysenck Personality Questionnaire（ EPQ-RSC） were employed to assess the patients after 1 month,3 months,6months and 12 months of admission and analyze the incidence of PSD in each time point and related factors. Results The incidence of PSD at 1 month,3 months,6 months and 12 months were 18. 75%,29. 03%,37. 70% and 31. 03%,respectively; the ratio of women and man with introverted personality in PSD patients after 1 month,3 months and 6 months was higher than that in non-PSD patients,with significant difference（ P 〈 0. 05）; The daily living score and social support score at 3 months,6 months and 12 months after stroke were significantly lower than that in the control group（ P 〈 0. 05）;The neurological deficit score in PSD patients was higher than that in the non-PSD patients（ P 〈 0. 05）. Logistic regression analysis showed that the incidence of PSD at 1 month after stroke was associated with the characteristics of introvert and female gender（ P 〈 0. 05）,at 3 months with women,daily life,social support and neurological deficits（ P 〈 0. 05）,and at12 months with the daily life,social support and neurological deficits（ P 〈 0. 05）. Conclusion The incidence of depression in stroke patients is high. We should pay close attention at early stage to women and patients with introverted personality in the clinical diagnosis,and at middle and late stage strengthen the monitor of daily life ability and social support and severe neurological deficit,taking early prevention and treatment methods to reduce the incidence of PSD.