围溶栓期心理支持对急性缺血性卒中患者卒中后抑郁的影响

Effect of psychological support during perithrombotic period on post-stroke depression in patients with acute ischemic stroke

目的探讨围溶栓期心理支持对急性缺血性卒中(acute ischemic stroke,AIS)患者发生卒中后抑郁(post-stroke depression,PSD)的影响。方法前瞻性纳入2021年1月1日至2021年7月31日在徐州医科大学附属连云港医院接受静脉溶栓治疗的AIS患者。干预组在接受标准静脉溶栓治疗基础上接受一对一的围溶栓期个体化心理支持治疗。在发病后30 d时采用汉密尔顿抑郁量表评估是否发生PSD。应用多变量logistic回归分析评估PSD的独立影响因素。结果共纳入126例AIS患者,其中男性86例(68.25%),年龄(63.65±10.46)岁;干预组65例,对照组61例;干预组PSD发生率显著低于对照组(20.00%对36.07%;χ^(2)=4.049,P=0.044)。多变量logistic回归分析显示,心理干预[优势比(odds ratio,OR)0.333,95%置信区间(confidence interval,CI)0.132~0.838;P=0.020]为AIS患者发生PSD的独立保护因素,而缺血性心脏病(OR 4.510,95%CI 1.181~17.217;P=0.028)、饮酒(OR 3.421,95%CI1.317~8.888;P=0.012)、抗凝治疗(OR 3.145,95%CI 1.155~8.567;P=0.025)和溶栓前改良Rankin量表评分(OR 1.627,95%CI 1.142~2.317;P=0.007)是发生PSD的独立危险因素。结论围溶栓期心理支持可降低PSD发生率。

Objective To investigate the effect of psychological support during perithrombotic period on post-stroke depression(PSD)in patients with acute ischemic stroke(AIS).Methods Patients with AIS received intravenous thrombolysis in the Affiliated Lianyungang Hospital of Xuzhou Medical University from January 1,2021 to July 31,2021 were enrolled prospectively.The intervention group received one-to-one individual psychological support therapy in the perithrombolytic period on the basis of receiving standard intravenous thrombolytic therapy.At 30 d after onset,Hamilton Depression Scale was used to assess whether PSD occurred.Multivariate logistic regression analysis was used to evaluate the independent influencing factor of PSD.Results A total of 126 patients with AIS were enrolled,and 86 of them were male(68.25%).Their age was 63.65±10.46 years;65 were in the intervention group and 61 were in the control group.The incidence of PSD in the intervention group was significantly lower than that in the control group(20.00%vs.36.07%;χ^(2)=4.049,P=0.044).Multivariate logistic regression analysis showed that psychological intervention(odds ratio[OR]0.333,95%confidence interval[CI]0.132-0.838;P=0.020)was an independent protective factor for PSD,while ischemic heart disease(OR 4.510,95%CI 1.181-17.217;P=0.028),alcohol consumption(OR 3.421,95%CI 1.317-8.888;P=0.012),anticoagulation therapy(OR 3.145,95%CI 1.155-8.567;P=0.025)and modified Rankin Scale score before thrombolysis(OR 1.627,95%CI 1.142-2.317;P=0.007)were the independent risk factors for PSD.Conclusion Perithrombolytic psychological support may reduce the incidence of PSD.