首发脑梗死rt-PA静脉溶栓患者卒中后抑郁临床分析  

Clinical study on relationship between post-stroke depression and intravenous thrombolysis with rt-PA in first cerebral infarction patients

作　　者：郑水红[1] 胡娅娜[1] 徐雪[1] 周蕾[1] 

机构地区：[1]浙江中医药大学附属金华市中医院神经内科,浙江省金华市321017

出　　处：《中华全科医学》2015年第6期916-918,共3页Chinese Journal of General Practice

基　　金：浙江省金华市科技局科研基金项目(2013-3-050)

摘　　要：目的观察首发脑梗死患者阿替谱酶(rt-PA)静脉溶栓后6个月末的卒中后抑郁(PSD)发生率,分析PSD与rt-PA静脉溶栓的相关性。方法连续收集首发脑梗死患者,根据是否接受rt-PA静脉溶栓治疗分为溶栓组和非溶栓组(对照组)。比较2组间年龄、性别、左前半球的梗死部位、教育程度、认知功能等基线因素,动态观察入院24 h内、6个月末NIHSS评分、汉密尔顿抑郁评分量表-17(HAMD-17)、简易精神状态量表(MMSE)评分,应用SPSS统计软件,单因素及多因素logistic回归分析PSD与rt-PA静脉溶栓的相关性。结果 58例患者纳入本次研究,溶栓组30例,对照组28例。单因素分析结果显示:2组间年龄、性别、左前半球的梗死部位、教育程度、24 h内NIHSS评分、MMSE评分、HAMD-17≥7分患者例数差异无统计学意义;6个月末NIHSS(P<0.05,P=0.036)评分有差异、HAMD-17≥7分患者例数(P<0.05,P=0.019)差异有统计学意义。6个月末使用HAMD-17评定卒中后抑郁程度:单因素分析示左前半球的梗死部位、24 h内NIHSS评分、6月末NIHSS评分、rt-PA静脉溶栓是影响PSD的重要因素。多因素分析显示左前半球的梗死部位、6个月末NIHSS评分是影响卒中后抑郁的独立危险因子,而rt-PA静脉溶栓是卒中后抑郁的保护因子。结论 rt-PA静脉溶栓对PSD有影响,rt-PA静脉溶栓是影响脑梗死患者6个月末PSD的独立保护因子。Objective To investigate the incidence of post-stroke depression（PSD） six month after the intravenous throm- bolysis with recombinant tissue plasminogen activator（ rt-PA, alteplase） in first cerebral infarction patients, and assess the correlation between PSD and rt-PA. Methods We prospectively collected consecutive registered data of acute ischemie patients. The patients were divided into thrombolysis group and non-thrombolysis group（ control group） based on intrave- nous rt-PA thrombolytic therapy. We compared the demographic, radiological variables and neurological outcome in 24 hours and in 6 months between thrombolysis group and non-thrombolysis group, including Mini-Mental State Examination （MMSE） ,Hamilton depression scale（ HAMD）, National Institutes of Health Stroke scale（NIHSS）. Univariate analysis and binary logistic regression were used to investigate the independent predictors for 6 month outcome. Results 58 pa- tients were enrolled in this study,including 30 thrombolytic patients and 28 non-thrombolytic patients. Univariate analysis showed that demographic, radiological variables and neurological outcome in 24 hours were no different between thrombol- ysis group and control group. Analysis also showed that NIHSS（ P 〈 0.01 ,P = 0. 036）scores and HAMD-17 （P 〈 0.05, P = 0. 019）were different between thrombolysis group and control group in 6 months. Univariate analysis showed that in- farction of left anterior position, NIHSS scores in 24 hours and in 6 months, use of rt-PA were different in patients with HAMD ≥7 （ P 〈 0.05 ） at 6 months. Binary logistic regression showed that infarction of left anterior position（ OR = 0. 525, 95% CI：O. 337 to 0. 712 ,P =0. 045） ,NIHSS scores in 6 months（ OR =0. 205,95% CI：O. 063 to 0.561 ,P =0. 024） were independent danger factors, and use of rt-PA （ OR = 1. 646,95 % CI： 1. 462 to 1. 835,P = 0. 039 ） were independent protec- tive factors for PSD at 6 months after onset of acute ischemic stroke. Conclusion Int

关 键 词：急性脑梗死 静脉溶栓 阿替谱酶 卒中后抑郁 

分 类 号：R743.33[医药卫生—神经病学与精神病学]