老年卒中患者康复治疗后6个月心理压力的变化及预测因素的研究

Changes of psychological stress and predictive factors in elderly patients with stroke after 6 months of discharge from rehabilitation

目的研究老年卒中患者康复治疗后6个月的心理压力变化及预测因素。方法选取2016年7月至2017年12月入住上海市第五康复医院康复科确诊为脑卒中再继续康复治疗的75例老年患者。记录每例患者入院时的基线变量。康复治疗后以住院测评及出院后电话门诊随访的形式分别于2周、3个月、6个月记录患者的感知压力量表、健康卒中量表、抑郁症量表-15评分。分别做2周与3个月,2周与6个月,3个月与6个月压力量表数值的单因素方差分析。以2周时间点测得的健康卒中量表评分、功能独立测量量表评分、抑郁量表评分作为自变量,以6个月时间点的感知压力量表评分作为因变量,做自变量与因变量的无序多分类Logistic回归分析。结果康复治疗后2周、3个月、6个月时间点的量表评分,不同时间点健康卒中量表评分,功能独立测量量表评分,抑郁症量表评分-15,感知压力量表评分-10比较差异有统计学意义(F=2.34~4.57,P<0.05)。康复治疗后2周与康复治疗后3个月,康复治疗后2周与康复治疗后6个月的感知压力量表评分比较差异有统计学意义(95%CI1.56~7.20、3.24~8.50,均P<0.05)。Logistic回归分析提示,急性脑卒中患者康复治疗后2周的功能独立性评分对心理压力为负影响,而抑郁症评分对心理压力为积极影响。结论急性脑卒中之后幸存患者的心理压力在3、6个月有下降趋势,康复治疗后2周的功能独立测量量表评分与抑郁症量表评分是康复治疗后6个月的心理压力的独立影响因素。

Objective To study the changes and predictors of psychological stress in elderly patients with acute stroke after 6 months of discharge. Methods Randomly selected patients who were admitted to the hospital from July 2017 to December 2017 were diagnosed as acutely stroke-free patients. Baseline variables were recorded for each patient at admission. After discharge from the hospital, the patient's perceptual pressure scale, the Healthy Stroke Scale, and the Depression Scale were recorded in the form of a follow-up visit to the patient at 2 weeks (T1), 3 months (T2), and 6 months (T3). 15 ratings. One-way ANOVA of the values of the T1 and T2, T1 and T3, T2 and T3 pressure gauges were performed. The healthy stroke scale score measured at the T1 time point, the functional independent measurement scale score, the depression scale score as the independent variable, and the perceived stress scale score at the T3 time point as the dependent variable, and the independent variable and the dependent variable. Disordered multi-class logistic regression analysis. Results After discharge, the scales of the two-week (T1), three-month (T2), and half-year (T3) time points were compared. The results showed that the health stroke scale scores at different time points (F=2.34), functional independent measurement scale scores (F=3.42), the depression scale score -15 (F=2.89), the perceived stress scale score-10 (F=4.57) was statistically different (P<0.05). There were statistical differences between the 2 weeks after discharge (T1) and 3 months after discharge (T2), 2 weeks after discharge (T1) and the second half of discharge (T3). There was a statistical difference (95% CI 1.56-7.20, 3.24-8.50, P<0.05). The results of Logistic regression analysis indicated that the functional independence score of patients with acute stroke after 2 weeks of discharge had a negative impact on psychological stress, while the depression score had a positive effect on psychological stress. Conclusions The psychological stress of surviving patients after acute stroke decreased at 3 months and 6 months. The functional independent measurement scale score and the depression scale score 2 weeks after discharge were psychological stress after discharge for 6 months. Independent influence factors.