急性高血压性脑出血术后患者抑郁及其危险因素分析

Analysis on depression and risk factors in patients after operation of acute hypertensive intracerebral hemorrhage

目的探讨急性高血压性脑出血患者术后各期卒中后抑郁(PSD)的发病特点和危险因素,为提高脑出血术后抑郁的诊治提供依据。方法选择2015年1月至2017年12月新乡医学院第一附属医院神经外科收住的259例急性脑出血行开颅血肿清除术患者作为研究对象,收集患者性别、年龄、职业类型、文化程度、婚姻状况、性格、家庭收入、有无近期负性事件、脑出血部位、脑出血量、有无高血压、烟酒史、有无失语、手术方式、美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力评定量表(ADL)评分、汉密尔顿抑郁量表(HAMD)评分等资料,依据手术后14 d HAMD24项评分结果分为非PSD组和PSD组,在术后14 d和3、6、12、18个月各随访1次,共评估5次,观察患者NIHSS评分、HAMD评分等变化情况,统计PSD患病率,评估PSD发生的危险因素。应用SPSS 21.0统计软件对数据进行独立样本t检验、配对t检验和χ^2检验,多因素相关分析采用逐步logistic回归分析。结果脑出血术后14 d患者PSD的点现患率为66.4%(172例),3个月时点现患率为42.5%(105例),6个月时点现患率为35.0%(84例),12个月时点现患率为33.0%(76例),18个月时点现患率为30.4%(68例),脑出血术后18个月内PSD的患病率为85.3%。PSD组职业类型、性格、失语、脑出血量、手术方式、入院时NIHSS评分、入院时ADL评分与非PSD组比较,差异均有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,入院时NIHSS评分、性格、职业类型、失语与PSD的发生独立相关(OR值分别为1.610、2.915、2.200和5.651,P<0.05,P<0.01)。两组患者NIHSS评分、HAMD评分在同一随访时点比较,差异均有统计学意义(P<0.05)。结论急性脑出血手术后PSD的患病率较高,随着术后康复,PSD的点现患率降低;入院时NIHSS评分、性格、职业类型、失语是首次急性脑出血术后PSD发生的独立危险因素,可通过调控危险因素予以干预。

Objective To explore the pathogenesis characters and risk factors of postoperative post-stroke depression(PSD)in patients with acute hypertensive intracerebral hemorrhage,and to provide the evidence for the diagnosis and treatment of PSD.Methods From January of 2015 to December of 2017,259 inpatients after operation of acute intracerebral hemorrhage in Department of Neurology of the First Affiliated Hospital of Xinxiang Medical University were selected as the subjects,the data of gender,age,professional type,education level,marital status,personality,family income,the recent negative event,cerebral hemorrhage site,cerebral hemorrhage volume,with or without hypertension,smoking and drinking,aphasia,operation type,National Institute of Health Stroke Scale(NIHSS)score,Activities of Daily Living Scale(ADL)score,Hamilton Depression Scale(HAMD)score and other information of subjects were collected;on the basis of HAMD 24 score,the subjects were divided into PSD group and non-PSD group,in 14 days,3,6,12 and 18 months the subjects were followed up one time,respectively;after 5 times of evaluation,changes of NIHSS score and HAMD score in subjects were observed,the morbidity and risk factors of PSD were analyzed.The independent t test,paired sample t test and χ^2 test were used to analyze the data,multivariate logistic regression was used to analyze the correlation.The used software was SPSS 21.0.Results The spot morbidities of PSD at 14 days,3 months,6 months,12 months and 18 months after operation of intracerebral hemorrhage were 66.4%(172 cases),42.5%(105 cases),35.0%(84 cases),33.0%(76 cases),and 30.4%(68 cases),respectively;and the morbidity of PSD in 18 months after the operation of intracerebral hemorrhage was 85.3%.There were statistically significant differences of occupational type,personality,aphasia,amount of intracerebral hemorrhage,operation type,NIHSS score at admission,and ADL score at admission between the PSD group and the non-PSD group,P<0.05,P<0.01.Multivariate logistic regression analysis showed that NIHSS score at admission,personality,occupational type and aphasia were independently correlated with the development of PSD(OR values were1.610,2.915,2.200 and 5.651,P<0.05,P<0.01).The NIHSS scores and HAMD scores between the two groups were statistically significant at the same follow-up point,P<0.05.Conclusion The morbidity of PSD after operation of acute intracerebral hemorrhage was higher,and the spot prevalence of PSD decreased with postoperative rehabilitation.NIHSS score at admission,personality,occupational type and aphasia were independent risk factors for PSD after operation of the first acute cerebral hemorrhage,which could be intervened by regulating the risk factors.