本文選題：卒中后抑郁　切入點(diǎn)：卒中部位　出處：《西南醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:探討初發(fā)腦卒中急性期患者卒中后抑郁的相關(guān)因素。方法:1.依據(jù)為漢米爾頓抑郁量表-17(HAMD-17)選擇96例初發(fā)腦卒中患者并將其劃分為抑郁和非抑郁組。2.根據(jù)缺血性卒中患者的牛津郡社區(qū)卒中項(xiàng)目(Oxfordshire Community Stroke Projec,OCSP)分型,分析研究各類型的卒中后抑郁(post-stroke depression,PSD)發(fā)病情況。3.對(duì)全部患者進(jìn)行美國國立衛(wèi)生院腦卒中量表(NIHSS評(píng)分)和蒙特利爾認(rèn)知評(píng)估量表(Montreal cognitive assessment scale,Mo CA)評(píng)分,并比較兩組患者的基本信息(主要有性別、年齡、文化程度、性格、近期負(fù)性事件、家庭關(guān)懷、收入、居住地、卒中類型等一般因素)、腦卒中發(fā)病部位、既往病史、病灶個(gè)數(shù)、NIHSS評(píng)分、OCSP分型、同型半胱氨酸、超敏C蛋白以及認(rèn)知功能進(jìn)行分析以便對(duì)比確定出PSD發(fā)生的主要影響因素。4.對(duì)所得結(jié)果利用SSPS17.0來分析,對(duì)計(jì)量和計(jì)數(shù)資料分別利用t和卡方檢驗(yàn)法進(jìn)行檢驗(yàn),P0.05表示結(jié)果存在統(tǒng)計(jì)學(xué)差異。結(jié)果:1、本研究選擇的研究對(duì)象總共有患者96例,利用漢密爾頓抑郁量表對(duì)這些患者進(jìn)行分組,將其分為抑郁組及無抑郁組,人數(shù)分別為34和62人。其PSD發(fā)生率為35.4%。2、對(duì)比兩組患者的基本信息如文化程度及卒中類型等因素之間沒有統(tǒng)計(jì)學(xué)意差異(p0.05);而性別、年齡、性格、近期負(fù)性事件、家庭成員的支持情況、收入狀況以及居住地等兩組患者有顯著差異(P0.05)。3、通過既往病史的調(diào)查研究,抑郁組與非抑郁組在高血壓、糖尿病以及合并癥等方面存在著極顯著性差異(P0.01),而在吸煙史和飲酒史方面無顯著差異(P0.05)。4、在病灶部位方面:結(jié)果表明左右側(cè)二組之間的PSD發(fā)生率無差異(P0.05)。按Starkstein法,并利用腦CT檢查方法得知,病灶位于大腦半球前、后側(cè)的PSD發(fā)生率存在差異(P0.05)。5、依據(jù)病灶發(fā)生在皮質(zhì)、基底節(jié)區(qū)及側(cè)腦室旁、小腦等部位,并統(tǒng)計(jì)對(duì)比兩組的PSD發(fā)病情況。結(jié)果表明這些部位兩組患者的抑郁發(fā)生情況不存在統(tǒng)計(jì)學(xué)差異(P0.05)。6、在OCSP分型方面:根據(jù)統(tǒng)計(jì)結(jié)果表明前循環(huán)梗塞出現(xiàn)抑郁的概率相對(duì)其余兩組的可能性更高,結(jié)果存在統(tǒng)計(jì)學(xué)差異(p0.05)。7、在病灶個(gè)數(shù)以及NIHSS評(píng)分方面,兩組患者均存在顯著差異(p0.05)。8、根據(jù)統(tǒng)計(jì)結(jié)果可知,抑郁組其同型半胱氨酸含量要顯著高于非抑郁組,且兩組具有極顯著差異(p0.01),而抑郁組其超敏C蛋白含量也要顯著高于非抑郁組,且兩組具有顯著差異(p0.05)。9、抑郁組Mo CA評(píng)分要顯著低于非抑郁組,且兩組具有極顯著差異(p0.01)。結(jié)論:1.本研究中腦卒中患者PSD急性期發(fā)生率為35.4%,以中輕度為主。2.PSD的發(fā)生與腦卒中部位、性格、有無家庭關(guān)懷、收入狀況以及居住地等一般資料有關(guān)。而在病灶個(gè)數(shù)、NIHSS評(píng)分方面、高血壓、糖尿病、同型半胱氨酸、超敏C反應(yīng)蛋白都是PSD的相關(guān)因素。3.缺血性卒中OCSP分型中,前循環(huán)梗塞患者發(fā)生PSD的概率高于后循環(huán)的。4.PSD對(duì)認(rèn)知功能有一定的影響。
[Abstract]:Objective: to investigate the related factors of post-stroke depression in patients with acute stroke. Methods: according to Hamilton Depression scale (-17HAMD-17), 96 patients with primary stroke were selected and divided into depression group and non-depression group. 2. Oxfordshire Community Stroke Project OCSP typing for stroke patients in Oxfordshire. To analyze the incidence of post-stroke depression (PSD) in all types of patients. All patients were assessed with the National Institutes of Health Stroke scale (NHS) and Montreal cognitive assessment scale (CA). The basic information of the two groups (sex, age, education, personality, recent negative events, family care, income, residence, type of stroke, etc.), the location of stroke, the history of stroke were compared. The number of lesions was evaluated by NIHSS score: OCSP classification, homocysteine, hypersensitive C protein and cognitive function in order to compare and identify the main factors influencing the occurrence of PSD. The results were analyzed by SSPS17.0. The data of measurement and counting were tested by t and chi-square test respectively. Results there were statistical differences between the two groups. Results: 1. A total of 96 patients were selected in this study. The patients were divided into two groups by Hamilton Depression scale (Hamilton Depression scale). The patients were divided into depression group and non-depression group (34 and 62, respectively). The incidence of PSD was 35.40.2.There was no significant difference in basic information such as education level and stroke type between the two groups, but there was no significant difference in sex, age, personality, and so on. Recent negative events, family members' support, income status and place of residence were significantly different between the two groups (P0.05. 3). According to the investigation of past medical history, depression group and non-depressive group were in hypertension. There were significant differences in diabetes mellitus and complications (P 0.01), but there was no significant difference in smoking history and drinking history (P 0.05. 4). The results showed that there was no difference in the incidence of PSD between the left and the right side of the two groups (P 0.05). According to the Starkstein method, there was no significant difference in the incidence of PSD between the left and the right side, according to the Starkstein method, there was no significant difference in the incidence of PSD between the two groups. The incidence of PSD in the front of the cerebral hemisphere and in the posterior side of the brain was different (P0.05. 5). According to the location of the lesion in the cortex, basal ganglia, lateral ventricle and cerebellum, the lesion was located in the cortex, basal ganglia, paraventricular and cerebellum. The results showed that there was no statistical difference in the incidence of depression between the two groups. In OCSP classification, the probability of depression in patients with anterior circulatory infarction was found according to the statistical results. The other two groups are more likely, Results there was significant difference in the number of lesions and the NIHSS score between the two groups. According to the statistical results, the homocysteine content in the depression group was significantly higher than that in the non-depression group. There was a significant difference between the two groups (P 0.01), while the content of hypersensitive C protein in depression group was significantly higher than that in non-depression group, and there was significant difference between the two groups (P < 0.05). The score of Mo CA in depression group was significantly lower than that in non-depression group. There was significant difference between the two groups (P 0.01). Conclusion: 1. The incidence of acute PSD in patients with middle stroke was 35.4g. 2.The incidence of PSDs was mainly moderate and mild, and the location, character, and family care of the patients with middle cerebral apoplexy. However, hypertension, diabetes, homocysteine, hypersensitive C-reactive protein were all related factors of PSD. 3. In the OCSP classification of ischemic stroke, hypertension, diabetes mellitus, homocysteine and hypersensitive C-reactive protein were related to the general data of PSD. The incidence of PSD in patients with anterior circulatory infarction was higher than that in posterior circulation. 4.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R743.3

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