脑卒中患者急性期发生抑郁的病例对照研究2.docVIP

脑卒中患者急性期发生抑郁的病例对照研究 【摘要】　目的 探讨脑卒中患者急性期发生抑郁的相关因素，为临床更有效地治疗脑卒中提供依据。方法 采用抑郁自评量表(SDS)、汉密尔顿抑郁量表(HAMD)对急性脑卒中患者153例和健康对照者80例进行测评,并且在脑卒中的不同病变性质之间、病灶部位之间以及病灶大小之间进行神经心理学的对照研究。结果　脑卒中后抑郁发生率为39.87%，高于健康对照组的13.75% (P0.01)；脑卒中组SDS 总分以及精神情感症状、躯体化障碍、精神运动性障碍、抑郁的心理障碍的评分也均明显高于健康对照组(P0.01)；在脑卒中组内左半球病变、多发病灶、大病灶和大脑前部受损者的神经心理学改变程度比右半球病变、单发病灶、小病灶和大脑后部受损者重(P0.05)。结论 急性脑卒中患者存在不同程度的抑郁症状，不同病变性质、部位、数量和面积，神经心理学改变也不同。脑卒中患者急性期抑郁的发病，可能主要与内在因素、大脑功能及皮质下结构的损害有关。 【关键词】　脑卒中；抑郁；心理健康状况 【中图分类号】　R743.3 　　【文献标识码】　A 　 The related factors of depression in the acute phase of stroke 　 【Abstract】Objective To investigate the acute phase of stroke in patients with depression relevant factors. Methods Hamilton depression rating scales ( HADM) and Zung’s self rating depression scales (SDS) were wsed to test in early acute stoke acute phase ( n = 153) and cont rol subjects ( n = 80 ) . The neuro-phsychology research was preformed in the patients who had different type of stroke , location in brain and volume. Results The significant difference was found in SDS between the two groups (P0.01). The neuron-phsychology change in cases of left hemisphere stroke was more obvious compare with the cases of the right hemisphere stroke (P0.05). The neuro-phsychology changes was more obvious in multiple lesions than in single lesions (P0.05). The neuro-phsychology change was more obvious in cases of big lesions than in small lesions (P0.05), and in front of brain than in post of brain (P0.05). Conclusion Incidence of depression are found to be high prevalent among stroke in acute stage. The patients with acute stage have more mental deficits than control group. It may have something with internal factors ,injure of brain function and subcortex structure. 【Key words】　Stroke; Depression;Mental health status 脑卒中具有高死亡率和高致残率的特点，是当今危害人类健康的最主要疾病之一。急性脑卒中患者可遗留有瘫痪、失语和神经心理学问题，尤其以抑郁、焦虑、躯体化等症状为主[1-3]，卒中后抑郁( PSD)作为常见的并发症，增加了患者痛苦，降低了患者的生活质量[4]。这些神经心理学方面的改变常常影响患者的预后，增加患者的并发症和病死率[ 5,6]。因此，研究PSD 发病和患病情况，阐明发生发展规律，对医疗和预防都具有重要意义。本研究旨在观察急性脑卒中患者的神经心理学改变