小卒中后情感淡漠发生率的动态变化及对患者生活质量的影响

The dynamic change of incidence and its influence on the quality of life in patients with minor post-stroke apathy

目的探讨小卒中后情感淡漠发生率的动态变化及对患者生活质量的影响。方法选取满足研究标准的106例急性小卒中(NIHSS≤3分)患者为研究组,106例健康体检者为对照组;应用淡漠评估量表(apathy evaluation scale,clinician version,AES-C)评估卒中后淡漠程度,分为小卒中后淡漠(minor post-stroke apathy mPSA)组与非卒中后淡漠(non post-stroke apathy NPSA)组,于发病后1个月、3个月、6个月、9个月、12个月时进行随访,进行AES-C评分、改良Barthel指数量表(MBI)评分、改良Rankin Scale量表(mRS)评分、脑卒中专用生活质量量表(SS-QOL)评分;分析小卒中后淡漠的发生率及其随时间的动态变化,比较mPSA组与NPSA组相关量表评分的差异。结果研究组中淡漠的发生率(35.1%)明显高于对照组(7.5%),差异有统计学意义(P<0.05);mPSA组MRS评分在卒中后1个月[(1.06±0.86)分]、3个月[(1.18±0.97)分]、6个月[(1.09±0.85)分]、9个月[(1.11±0.71)分]、12个月[(1.11±0.72)分],与NPSA组1个月[(1.00±0.89)分],3个月[(0.95±0.83)分]、6个月[(0.97±0.87)分]、9个月[(1.00±0.80)分]、12个月[(1.03±0.79)分]比较均差异无统计学意义(P>0.05);mPSA组MBI评分在卒中后1个月[(92.42±5.75)分]、3个月[(91.32±5.81)分]、6个月[(91.71±5.14)分]、9个月[(91.67±4.78)分]、12个月[(91.14±5.01)分],与NPSA组1个月[(91.97±5.79)分]、3个月[(92.42±5.64)分]、6个月[(92.29±5.67)分]、9个月[(92.07±5.46)分]、12个月[(92.12±5.35)分]比较均差异无统计学意义(P>0.05);mPSA组SS-QOL评分在卒中后1个月[(135.09±26.88)分]、3个月[(132.71±24.91)分]、6个月[(134.31±26.63)分]、9个月[(135.89±24.86)分]、12个月[(138.77±27.83)分],低于NPSA组1个月[(183.79±24.80)分]、3个月[(183.77±24.18)分]、6个月[(181.80±26.62)分]、9个月[(179.86±28.92)分]、12个月[(179.98±29.13)分],差异有统计学意义(均P<0.05);各随访时间点mPSA发生率比较差异无统计学意义(P>0.05)。结论小卒中后情感淡漠的发生率较对照组明显增高,在发病后12个月仍保持较高水平,严重影响患者的生活质量。

Objective To explore the incidence and dynamic change of apathy after minor stroke and its influence on the quality of life.Methods One hundred and six patients with minor stroke(NIHSS≤3)were selected as the research group,one hundred and six cases with healthy physical examination were selected as control group.The apathy evaluation scale,clinician version(AES-C)scale was used to evaluate the degree of apathy after minor stroke,then the patients were divided into minor post-stroke apathy group(mPSA group)and non post-stroke apathy group(NPSA group).At 1,3,6,9 and 12 months after onset,the follow-up visits were carried out and AES-C,modified Barthel index(MBI),modified Rankin scale(mRS)and stroke-specific quality of life scale(SS-QOL)were evaluated.The incidence of minor post-stroke apathy and its dynamic changes over time were analyzed,and the differences of related scales scores between the mPSA group and the NPSA group were compared.Results The incidence of apathy in research group(35.1%)was higher than that of the control group(7.5%)(P<0.05).The scores of MRS in the mPSA group at 1 month(1.06±0.86),3 months(1.18±0.97),6 months(1.09±0.85),9 months(1.11±0.71),12 months(1.11±0.72)after stroke were not significantly different from those in the NPSA group at 1 month(1.00±0.89),3 months(0.95±0.83),6 months(0.97±0.87),9 months(1.00±0.80),12 months(1.03±0.79)(all P>0.05).The scores of MBI in the mPSA group at 1 month(92.42±5.75),3 months(91.32±5.81),6 months(91.71±5.14),9 months(91.67±4.78),12 months(91.14±5.01)after stroke were not significantly different from those in the NPSA group at 1 month(91.97±5.79),3 months(92.42±5.64),6 months(92.29±5.67),9 months(92.07±5.46),12 months(92.12±5.35)(all P>0.05).The scores of SS-QOL in the mPSA group at 1 month(135.09±26.88),3 months(132.71±24.91),6 months(134.31±26.63),9 months(135.89±24.86),12 months(138.77±27.83)after stroke were lower than those in the NPSA group at 1 month(183.79±24.80),3 months(183.77±24.18),6 months(181.80±26.62),9 months(179.86±28.92),12 months(179.98±29.13)(all P<0.05).There were no significant differences in the incidence of mPSA at each time point of follow-up(P>0.05).Conclusion The incidence of apathy after minor stroke is significantly higher than that of the control group,and it remains relatively stable in the first year and seriously affect the quality of patients'life.