急性缺血性脑卒中后焦虑状态对自主神经功能及预后影响研究

Study on the effect of anxiety on autonomic nervous function and prognosis after acute ischemic stroke

目的探讨急性缺血性脑卒中(AIS)后焦虑状态对自主神经功能及预后的影响。方法将2021年7月至2021年10月宿州市第一人民医院收治的100例发病48 h内就诊的AIS患者纳入本次前瞻性研究;将汉密尔顿焦虑量表(HAMA)评分≥14分的患者纳入焦虑组(n=70),将HAMA评分<14分的患者纳入非焦虑组(n=30);焦虑组患者又根据抗焦虑治疗不同分成干预1组(n=35)和干预2组(n=35)。所有患者均接受AIS常规治疗,干预1组患者还需接受心理干预,干预2组患者接受心理干预+抗焦虑药物治疗。比较反应自主神经功能指标[心率、正常窦性RR间期的总体标准差(SDNN)、心率变异系数(HRV1)、正常连续窦性RR间期差值均方根(rMSSD)、相邻RR间期差值>50 ms百分比(PNN50)、NN间期平均值标准差(SDANN)]、HAMA评分、汉密尔顿抑郁量表(HAMD)评分。随访6个月后的预后不良发生情况。结果焦虑组的心率为(81.0±5.2)次/min,较非焦虑组[(71.5±5.0)次/min]显著加快,而HRV1、SDANN、PNN50、rMSSD、SDNN为(8.6±1.5)%、(25.7±4.6)mV、(3.4±1.7)%、(21.1±4.2)ms、(30.7±7.1)ms,均较非焦虑组[(13.6±1.7)%、(110.5±10.9)mV、(10.8±2.2)%、(31.0±4.8)ms、(107.3±6.8)ms]显著下降,焦虑组的HAMA评分、HAMD评分为(18.0±5.1)、(17.2±3.9)分,均较非焦虑组[(5.9±1.0)、(6.2±1.5)分]显著升高,差异均有统计学意义(P<0.05)。治疗8 d后,干预2组的心率为(70.5±4.6)次/min,较干预1组[(79.3±4.9)次/min]显著下降,而HRV1、SDANN、PNN50、rMSSD、DNN为(13.7±1.7)%、(52.4±7.1)mV、(6.5±2.8)%、(31.7±4.8)ms、(56.0±7.4)ms,均较干预1组[(9.5±1.9)%、(30.2±6.1)mV、(4.3±2.0)%、(25.1±4.5)ms、(34.9±7.0)ms]显著升高,干预2组的HAMA评分和HAMD评分分别为(12.7±2.3)、(13.2±2.8)分,均较干预1组[(16.4±4.5)、(16.2±3.2)分]显著降低,差异均有统计学意义(P<0.05)。随访6个月后,焦虑组预后不良发生率为12.9%,高于非焦虑组的6.7%,但组间差异无统计学意义(P>0.05)。结论合并焦虑的AIS患者自主神经功能明显异常,氟哌噻吨美利曲辛片能够有效改善AIS患者的自主神经功能、焦虑及抑郁状态,也能一定程度改善预后。

Objective To explore the effect of anxiety on autonomic nervous function and prognosis after acute ischemic stroke(AIS).Methods A total of 100 AIS patients admitted to the First People's Hospital of Suzhou from July 2021 to October 2021 were enrolled in this prospective study,and the patients were divided into anxiety group(n=70,HAMA>14)and non-anxiety group(n=30,HAMA≤14)according totheHAMA scores.Patients in the anxiety group were randomly divided into intervention group 1(n=35)and intervention group 2(n=35).Patients in both the anxiety group and the non-anxiety group received routine AIS treatment.Patients in the intervention group 1 also received psychologicalintervention,and patients in the intervention group 2 received psychological intervention+drug therapy.The response autonomic nervous function index[including heart rate,standard diviation of NN intervals(SDNN),heart rate variability(HRV1),root mean square of successive differences(rMSSD),percentage of adjacent RR intervals>50 ms(PNN50),NN interval mean standard deviation(SDANN)],the HAMA and HAMD scores were compared,and the prognosis of 6 months follow-up.Results The HR in the anxiety group was(81.0±5.2)beats/min,which was much higher than that in the non-anxiety group[(71.5±5.0)beats/min],while the HRV1,SDANN,PNN50,rMSSD and SDNN in the anxiety group were(8.6±1.5)%,(25.7±4.6)mV,(3.4±1.7)%,(21.1±4.2)ms,(30.7±7.1)ms,respectively,which were much lower than those in the non-anxiety group[(13.6±1.7)%,(110.5±10.9)mV,(10.8±2.2)%,(31.0±4.8)ms,(107.3±6.8)ms],the scores of HAMA and Hamd in anxiety group were(18.0±5.1),(17.2±3.9)pionts,which were significantly higher than those in non-anxiety group[(5.9±1.0),(6.2±1.5)pionts],the differences were statistically significant(P<0.05).After treatment,the heart rate of the intervention group 2 was(70.5±4.6)beats/min,which was much lower than that of the intervention group 1[(79.3±4.9)beats/min],while the HRV1,SDANN,PNN50,rMSSD and SDNN of the intervention group 2 were(13.7±1.7)%,(52.4±7.1)mV,(6.5±2.8)%,(31.7±4.8)ms,(56.0±7.4)ms,which were much higher than those of intervention group 1[(9.5±1.9)%,(30.2±6.1)mV,(4.3±2.0)%,(25.1±4.5)ms,(34.9±7.0)ms],the HAMA score and HAMD score of intervention group 2 after treatment were(12.7±2.3),(13.2±2.8)points,which were lower than those of intervention group 1[(16.4±4.5),(16.2±3.2)points],the differences were statistically significant(P<0.05).After 6months follow-up,the incidence of poor prognosis in anxiety group was 12.9%,while non-anxiety group was 6.7%,there was no significant difference between groups(P>0.05).Conclusion The autonomic nervous function of AIS patients with anxiety is obviously abnormal.Haloperidoxine melitracine tablets can effectively improve the autonomic nervous function,anxiety and depression of AIS patients,and improve the prognosis to some extent.