脑卒中后不同时段抑郁与认知功能相关性研究  

The correlation of depression and cognitive function with poststroke in different period

作　　者：赵晓晖[1] 杨娟[1] 许佩佩[2] 周媛[1] 白青科[1] 陈翠荣[1] 沈建[1] 

机构地区：[1]上海市浦东新区人民医院神经内科,上海201200 [2]上海市浦东新区人民医院神经电生理室,上海201200

出　　处：《脑与神经疾病杂志》2013年第4期241-244,共4页Journal of Brain and Nervous Diseases

基　　金：上海市浦东新区卫生系统优秀学科带头人培养基金项目(PWRdJ2007-02)

摘　　要：目的探讨脑卒中后不同时段抑郁与认知功能的相关性,并指导临床监测和干预。方法选择住院病例223例并确诊为急性期脑卒中,于卒中后72h行HAMD评分,≥8分的病例随机分为抗抑郁药物干预组、未干预组,<8分者1个月再次HAMD评分,其中≥8分的病例相同方法再分为干预组、未干预组,<8分者2个月再予评分,其中≥8分者相同方法再分为干预组、未干预组,<8分者3个月再次评分,分为≥8分和<8分组,各组病例在卒中后72h、3个月进行MoCa量表评分、P300检测。本文对脑卒中后不同时段抑郁未干预组72h、3个月时的MoCa评分、P300指标进行比较分析。结果①各未干预组72h、3个月时MoCa评分的比较:72h、3M时,72h组与1个月、2个月、3个月组比较,P均<0.01;72h时与3个月时比较:72h组P<0.05,1个月组P<0.01,2个月组P<0.01;3个月组P<0.05;②各未干预组72h、3个月时P300的比较:72h、3个月时,1个月、2个月组较72h、3个月组均有显著性差异;72h时与3个月时比较:1个月、2个月组潜伏期前后比较,P均<0.01。结论通过MoCa量表发现脑卒中后抑郁(PSD)患者存在不同程度的认知功能损害,其中以亚急性期、恢复期较明显,但其评分结果的准确性、真实性受到一定的限制;P300具备客观、敏感性高等优势,反映出1个月、2个月发生PSD对患者认知功能的影响更显著。所以应对脑卒中患者进行PSD及其认知功能的定期筛查,有针对性地尽早干预,全面改善患者的预后。Objective To observe the correlation of depression and cognitive function with poststroke in different time and guide clinical monitoring and intervention.Methods Two hundred and twenty-three consecutive patients with stroke within 72 hours of symptom onset were included.The patients were scored by Hamilton Depression Scale（HAMD;24-item version） after 72h of symptom onset.The patients whose score（HAMD） were ≥8 were randomly allocated into intervention group and non-intervention group.The patients whose score were ≤8 were scored by HAMD again at the time one month and whose HAMD score were≥8 were randomly allocated into intervention group and non-intervention group again.The same as before,the patients whose HAMD score≤8 were scored by HAMD at the time three month and allocated into HAMD score≥8 and HAMD score≤8.ALL patients were scored by MoCa scale score and P300 detection at the time 72h and three month.The MoCa scale score and P300 detected at the time 72h and three month were analyzed in the patients with poststroke depression（PSD） who were allocated into non-ntervention groups.Results ①MoCa scale score was compared at the time 72 hour and 3 month among every on-ntervention group.The MoCa scale score of patients at the time 72hour was different from the patients at the same time period 1,2 and 3 month（P 0.01）.The MoCa scale score of the patients who were randomly allocated into on-ntervention group at the time 72 hour was different between 72hour and 3month（P 0.05）,and the same as the MoCa scale score of the patients who were randomly allocated into on-ntervention group at the time 1,2 and 3 month（P 0.01）.② P300 was compared at the time 72 hour and 3 month among every on-ntervention group.The P300 of the patients whom were randomly allocated into on-ntervention group at the time 1month and 2month were different from the 72hour and 3 month significantly.The P300 of the patients both who were randomly allocated into on-ntervention group at the time 1month and 2month were

关 键 词：脑卒中 卒中后抑郁 MOCA量表 P300 

分 类 号：R743.32[医药卫生—神经病学与精神病学]