本文選題：腦梗死 + 靜脈溶栓��； 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：目的:本研究通過收集大連醫(yī)科大學附屬第一醫(yī)院神經內科腦梗死患者的相關信息,旨在描述腦梗死患者rt-PA靜脈溶栓治療3個月末卒中后抑郁(Post-Stroke Depression,PSD)的發(fā)生率及嚴重程度,分析卒中后抑郁的可能影響因素,進而探討各影響因素與rt-PA靜脈溶栓治療腦梗死患者出現卒中后抑郁的不同程度之間的關系。方法:選擇2016年1月1日至2016年10月31日期間大連醫(yī)科大學附屬第一醫(yī)院神經內科收治的符合入組標準的腦梗死患者為研究對象,本次研究經隨訪3個月剔出失訪及死亡患者后,入組103例患者,其中男性患者70例,占67.96%,女性患者33例,占32.04%,男女比例2.12:1。按照是否接受rt-PA靜脈溶栓治療分為溶栓組和非溶栓組(對照組),按照自制調查表(自制患者基本信息采集表、自制出院患者隨訪表)收集患者各項臨床資料,記錄患者患病3個月末NIHSS(NationalInstitutes of Health Stroke scale)評分、mRS(modified Rankin Scale)評分、HAMD-17(Hamilton Depression Scale)評分。首先根據是否接受溶栓治療比較兩組患者基線資料是否存在差異,再對卒中后抑郁發(fā)生率及抑郁嚴重程度進行分析;探討腦梗死患者3個月末卒中后抑郁的相關影響因素,進而比較主要影響因素與患者不同抑郁程度之間的關系。使用SPSS19.0軟件包建立數據庫,采用t檢驗、卡方檢驗、秩和檢驗、單因素分析、多因素條件Logistic回歸分析進行數據處理以及統(tǒng)計學分析。結果:1、103例腦梗死患者一般資料的組間比較差異無統(tǒng)計學意義(P0.05)。2、在103例腦梗死患者中,3個月末發(fā)生卒中后抑郁患者35例,發(fā)生率為33.98%。其中溶栓組3個月末發(fā)生卒中后抑郁患者為14例,發(fā)生率占103例腦梗死患者的13.59%,占溶栓組患者的25.00%;非溶栓組3個月末發(fā)生卒中后抑郁患者為21例,發(fā)生率占103例腦梗死患者的20.39%,占非溶栓組患者的44.68%。對溶栓組和非溶栓組3個月末卒中后抑郁的發(fā)生率進行比較,結果顯示:溶栓組無抑郁的患者占103例腦梗死患者的比例明顯高于非溶栓組,非溶栓組發(fā)生抑郁的患者占103例腦梗死患者的比例明顯高于溶栓組。兩組患者的卒中后抑郁程度差異有統(tǒng)計學意義(P=0.031)。3、在選取的可能對腦梗死患者3個月卒中后抑郁產生影響的16項因素中,其中3項因素:護理人員(P=0.017)、3個月末的mRS評分(P=0.004)以及靜脈溶栓治療溶栓(P=0.013)是腦梗死患者3個月末卒中后抑郁的影響因素。4、護理人員對患者發(fā)生重度抑郁的影響差異有統(tǒng)計學意義(P=0.002);患者的3個月末的mRS評分對輕度、中度以及重度三種不同程度卒中后抑郁均有影響,差異均有統(tǒng)計學意義(P=0.006,P=0.000,P=0.000);溶栓治療對患者發(fā)生重度抑郁的影響差異有統(tǒng)計學意義(P=0.045)。其中溶栓組中,患者的3個月末的mRS評分對患者輕度、中度以及重度三種不同程度卒中后抑郁均有影響,差異有統(tǒng)計學意義(P=0.004,P=0.000,P=0.024);非溶栓組中,護理人員對患者發(fā)生重度抑郁的影響差異有統(tǒng)計學意義(P=0.007);患者的3個月末的mRS評分對輕度、中度以及重度三種不同程度卒中后抑郁均有影響,差異有統(tǒng)計學意義(P=0.019,P=0.002,P=0.006)。結論:1、rt-PA靜脈溶栓治療不僅可以明顯減少腦梗死患者3個月末卒中后抑郁的發(fā)生,而且還能夠明顯降低腦梗死患者3個月末卒中后抑郁的嚴重程度;2、護理人員、3個月末mRS評分和靜脈溶栓治療與腦梗死患者3個月末PSD發(fā)生相關;3、不同的護理人員(家屬護理/護工護理)與腦梗死患者(特別是非靜脈溶栓治療的腦梗死患者)3個月末重度卒中后抑郁的發(fā)生相關;腦梗死患者3個月末神經功能改善情況與其3個月末輕度、中度、重度抑郁的發(fā)生相關;腦梗死患者急性期接受溶栓治療與腦梗死患者3個月末重度卒中后抑郁的發(fā)生相關。
[Abstract]:Objective: This study aims to describe the incidence and severity of Post-Stroke Depression (PSD) in patients with cerebral infarction at the end of 3 months of cerebral infarction by collecting the related information of cerebral infarction in the Department of Neurology, the First Affiliated Hospital of Dalian Medical University, and to analyze the possible influencing factors of post stroke depression, and then to discuss the effects of each image. The relationship between sound factors and rt-PA intravenous thrombolytic therapy in the treatment of post-stroke depression in patients with cerebral infarction. Methods: selected patients who were admitted to the Department of Neurology of the First Affiliated Hospital of Dalian Medical University from January 1, 2016 to October 31, 2016 were selected as the subjects of cerebral infarction which were in accordance with the standard of entry group. This study was followed up for 3 months. After the loss of and death, 103 patients were enrolled in the group, of which 70 were male, 67.96% and 33 in women, accounting for 32.04%. 2.12:1. was divided into thrombolytic and non thrombolytic group (control group) according to whether rt-PA intravenous thrombolytic therapy was accepted, according to self-made questionnaire (self-made basic information collection table, homemade follow-up list of discharged patients) NIHSS (NationalInstitutes of Health Stroke scale) score, mRS (modified Rankin Scale) score, HAMD-17 (Hamilton) score were recorded at the end of 3 months of the patient's illness. First, whether there was a difference in baseline data between the two groups according to whether or not to accept thrombolytic therapy, and then the incidence of post stroke depression Analysis of the severity of depression and the related factors of post-stroke depression in patients with cerebral infarction at the end of 3 months, and then comparing the relationship between the main factors and the degree of depression in the patients. Using the SPSS19.0 software package to establish a database, using t test, chi square test, rank test, single factor analysis, and multiple factor conditional Logistic regression Data processing and statistical analysis were carried out. Results: there was no significant difference in the general data between 1103 patients with cerebral infarction (P0.05).2. Among the 103 patients with cerebral infarction, 35 cases of post-stroke depression occurred at the end of 3 months, the incidence of which was 33.98%. in the thrombolytic group and the incidence of post-stroke depression in 14 cases at the end of 3 months of thrombolytic therapy. 13.59% of the 103 patients with cerebral infarction accounted for 25% of the thrombolytic group, and 21 cases of post-stroke depression in the non thrombolytic group at the end of 3 months, accounting for 20.39% of the 103 patients with cerebral infarction, accounting for the incidence of post-stroke depression in the thrombolytic and non thrombolytic groups at the end of 3 months in the non thrombolytic group, and the results showed that the thrombolytic group had no inhibitory effect on the incidence of post-stroke depression at the end of 3 months. The results showed that there was no inhibition in thrombolytic group in the thrombolytic group. The results showed that the thrombolytic group had no inhibition on the incidence of depression after stroke. The results showed that the thrombolytic group had no inhibition on the incidence of depression after stroke. The results showed that the thrombolytic group had no inhibition on the incidence of depression after stroke. The proportion of depressed patients in 103 patients with cerebral infarction was significantly higher than that in non thrombolytic group. The proportion of 103 patients with cerebral infarction in the non thrombolytic group was significantly higher than that in thrombolytic group. The difference of post stroke depression in the two groups was statistically significant (P=0.031).3, and the selection could produce a shadow of post-stroke depression after 3 months of cerebral infarction. Of the 16 factors, 3 factors: the nursing staff (P=0.017), the mRS score at the end of 3 months (P=0.004) and the thrombolytic thrombolytic thrombolysis (P=0.013) were the factors affecting the post-stroke depression of the patients at the end of the cerebral infarction (.4), and the nursing staff had a statistically significant difference in the effect of severe depression (P=0.002), and the mRS at the end of the 3 month of the patient. The scores had significant effects on three different degrees of post-stroke depression in mild, moderate and severe cases (P=0.006, P=0.000, P=0.000), and the difference in the effect of thrombolytic therapy on severe depression was statistically significant (P=0.045). In the thrombolytic group, the patients' mRS scores at the end of 3 months were mild, moderate, and severe. Three different degrees of post-stroke depression had a significant difference (P=0.004, P=0.000, P=0.024); in the non thrombolytic group, the nursing staff had a significant difference in the effect of severe depression (P=0.007), and the mRS score at the end of 3 months had an effect on the mild, moderate and severe post-stroke depression in three different degrees, The difference was statistically significant (P=0.019, P=0.002, P=0.006). Conclusion: 1, rt-PA intravenous thrombolytic therapy can not only significantly reduce the incidence of post-stroke depression in patients with cerebral infarction at the end of 3 months, but also significantly reduce the severity of post-stroke depression in patients with cerebral infarction at the end of 3 months; 2, nursing staff, mRS scores and intravenous thrombolytic therapy at the end of 3 months, and the treatment of thrombolytic therapy at the end of 3 months. Patients with cerebral infarction were associated with PSD at the end of 3 months; 3, different nurses (family care / nursing care) were associated with the occurrence of severe post-stroke depression at the end of 3 months of cerebral infarction (especially in patients with cerebral infarction treated by non intravenous thrombolytic therapy); the improvement of nerve function at the end of 3 months of cerebral infarction was mild, moderate, and severe depression at the end of the month of 3 months. Thrombolytic therapy in patients with cerebral infarction at acute stage is associated with the occurrence of severe stroke depression at the end of 3 months in patients with cerebral infarction.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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