急性脑梗死吞咽困难患者抑郁状态相关性分析

Analysis of depression status in patients with dysphagia after acute cerebral infarction

目的探讨急性脑梗死吞咽困难患者发生抑郁状态发病情况及相关因素分析,为临床预后及制定康复方案提供参考。方法选取108例急性脑梗死住院患者为研究对象,入院时所有患者经吞咽功能评估,入院7d后完成汉密尔顿抑郁量表(Hamilton Depression Rating Scale,HAMD)评定,根据洼田饮水实验将患者分为有吞咽困难组和吞咽正常组,根据HAMD评分将吞咽困难组患者分为卒中后抑郁(post-stroke depression,PSD)组(总评分≥8分)和卒中后非抑郁(no-post stroke depression NPSD)组(总评分<8分),抑郁组患者分为轻度抑郁组(8~20分),中度抑郁组(21~35分)和重度抑郁组(大于35分)。统计分析有吞咽困难组和吞咽正常组抑郁症状检出率;并对吞咽困难组中抑郁组与非抑郁组进行一般资料、相关病史危险因素的比较分析。通过吞咽功能分级及HAMD评分,进一步比较抑郁的严重程度与吞咽功能之间的关系。结果吞咽困难组中有抑郁症状者36例,占69.2%,抑郁检出率高于无吞咽困难组(35.7%),差异有统计学意义(P<0.05);将吞咽困难组伴有抑郁与不伴有抑郁的患者进行一般资料、病史、危险因素分析,比较发现糖尿病、吸烟史差异有统计学意义;分析吞咽困难组各级别以及每级别的数量和评分,发现吞咽功能障碍级别越高,越容易出现抑郁,抑郁的程度越严重。结论伴有吞咽困难的急性脑梗死患者有较高的抑郁发生率,吞咽功能障碍级别越高,越容易出现抑郁,抑郁的程度越严重,在进行吞咽康复治疗前有必要对吞咽困难患者的抑郁状态进行抑郁量表的检测评估;急性脑梗死中吞咽困难患者发生PSD可能与糖尿病史、吸烟史有关。

Objective To investigate the incidence of depression and related factors in patients with dysphagia after acute cerebral infarction,and to provide reference for clinical prognosis and rehabilitation programs.Methods A total of 108 hospitalized patients with acute cerebral infarction were enrolled.All patients were assessed by swallowing function.Seven days after admission,the Hamilton Depression Rating Scale(HAMD) was assessed.According to the Putian drinking experiment,patients were divided into Patients with dysphagia and dysphagia were divided into patients with dysphagia according to HAMD scores into post-stroke depression(PSD) group(total score≥8 points) and post-stroke non-depression(no-post stroke depression NPSD).The group(total score<8 points),the depression group were divided into mild depression group(8~20 points),moderate depression group(21~35 points) and severe depression group(more than 35 points).Statistical analysis showed the detection rate of depressive symptoms in the dysphagia group and the non-dysphagia group.The general data and related medical risk factors were compared between the dysphagia group and the non-depression group.The relationship between the severity of depression and the swallowing function score was further compared by swallowing function score.Results Among the dysphagia group,36 patients had depressive symptoms,accounting for 69.2%.The detection rate of depression was higher than that without dysphagia.The difference was statistically significant(P<0.05).The dysphagia group was accompanied by depression and without depression.Patients were analyzed for general data,medical history,and risk factors.The differences in diabetes and smoking history were statistically significant.The number and scores of each level and level of dysphagia were analyzed.It was found that the higher the level of swallow dysfunction,the more likely it was to appear.Depression,the more severe the depression.Conclusion Patients with acute cerebral infarction with dysphagia have a higher incidence of depression.The higher the level of swallowing dysfunction,the more likely it is to have depression.The more severe the degree of depression,the need for depression in patients with dysphagia before swallowing rehabilitation.The state was tested for depression scale.PSD in patients with dysphagia in acute cerebral infarction may be related to the history of diabetes and smoking history.