脑出血恢复期抑郁症发生的相关危险因素  

Melancholia incidence in the convalescence period of cerebral hemorrhage and its correlated factors

作　　者：林香玉[1] 李玉辉[2] 李静[1] 张金刚[1] 陈润青[1] 

机构地区：[1]山东省烟台经济技术开发区医院神经内科,264006 [2]山东省烟台市烟台山医院保健科,264001

出　　处：《中国医师进修杂志》2011年第31期31-34,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨脑出血恢复期抑郁症的相关危险因素及防治对策。方法选择98例脑出血恢复期患者，用汉密尔顿抑郁量表（HAMD）进行抑郁症评估，以国立卫生研究院卒中量表（NIHSS）进行神经功能缺损评估，用蒙特利尔认知量表（MoCA）进行认知功能评估，用改良Rankin量表（mRS）进行神经功能恢复情况评估。颅脑CT确定脑出血的部位、出血量。经颅多普勒测定大脑中动脉、大脑前动脉和大脑后动脉的脉冲频谱和血流参数。结果98例脑出血恢复期患者中抑郁症发生率为51．0％（50／98），其中男性发生率为34．0％（17／50），女性发生率为68．8％（33／48），两者比较差异有统计学意义（P〈0．05）。经过等级相关系数检验，NIHSS、mRS评分与HAMD评分呈正相关（P〈0．05），与MoCA评分呈负相关（P〈0．05）。出血部位为额叶时抑郁症发生率较高[76．2％（16／21）]，脑出血量在20～40ml时抑郁症发生率较高[62．5％（25／40）]。脑出血恢复期患者中，抑郁症患者的大脑中动脉、大脑前动脉平均血流速度低于非抑郁症患者，阻力指数高于非抑郁症患者，差异均有统计学意义（P〈0．05）。结论脑出血恢复期抑郁症的发生与NIHSS、MoCA评分及性别、出血部位、出血量有显著的相关性。抑郁症患者的脑血流速度明显低于非抑郁症患者，阻力指数明显高于非抑郁症患者。Objective To evaluate the melancholia incidence in the convalescence period ofcerebral hemorrhage and its correlated factors. Methods Ninety-eight cerebral hemorrhage patients in the convalescence period were involved in this study. Melancholia was assessed by Hamilton depression scale （HAMD）, neural functional deficiency was assessed by the national institute of health stroke scale （NIHSS）, cognitive function deficiency was assessed by the Montreal cognitive assessment （MoCA） and neural functional deficiency recovery was assessed by modified Rankin scale （mRS）. Hemorrhagic site and blood quantity were detected with CT. The blood flow of middle cerebral artery （MCA）,anterior cerebral artery （ACA）, posterior cerebral artery （PCA） was detected by TCD. Results The melancholia incidence in the convalescence period was 51.0% （50/98）, 34.0% （17/50） in males and 68.8% （33/48） in females, there was significant difference between the two （P 〈 0.05 ）. The scores of NIHSS and mRS had significantly positive correlation with HAMD （P 〈 0.05 ）, and had significandy negative correlation with MoCA（P 〈 0.05 ）. When the hemorrhagic site was in frontal lobe and blood quantity was 20-40 ml, the melancholia incidence was increased [76.2% （16/21）, 62.5% （25/40）]. The average blood velocity of MCA,ACA and PCA in melancholia patients was significantly slower than that without melancholia patients, while resistance index was significantly higher in melancholia patients （P 〈 0.05 ）. Conclusions Melancholia incidence in the convalescence period of cerebral hemorrhage has positive correlation with sex, NIHSS, MoCA, hemorrhagic site and blood quantity. The average cerebral blood flow in the melancholia patients is significandy slower and resistance index is significantly higher.

关 键 词：脑出血 抑郁症 危险因素 脑血流量 

分 类 号：R722.151[医药卫生—儿科]