首次急性脑梗死患者发生卒中后抑郁的危险因素分析  

Analysis of Risk Factors for Post-stroke Depression in Patients with Acute Cerebral Infarction

作　　者：孙志[1] 邢效如[1] 揣兰香 赵新春[1] 郝亚楠 

机构地区：[1]中国人民解放军第254医院神经内科,天津市300000

出　　处：《医学理论与实践》2017年第22期3296-3298,3318,共4页The Journal of Medical Theory and Practice

摘　　要：目的:探讨首次急性脑梗死患者发生卒中后抑郁的危险因素。方法:收集2014年10月-2017年4月我院神经内科收治的360例首次急性脑梗死患者临床资料,采用精神障碍诊断和统计手册第5版(DSM-V)标准,对患者卒中后抑郁进行诊断,分为卒中后抑郁(PSD)组和非抑郁(非PSD)组。采用单因素分析及Logistic风险模型分析首次急性脑梗死患者发生卒中后抑郁发生的相关危险因素。结果:(1)360例患者中共有130例患者出现PSD,发生率为36.1%,在发病后的7d、14d、3个月、6个月、1年分别确诊15例、26例、35例、24例、30例。根据HAMD评分结果,130例PSD患者中,轻度组、中度组、重度组分别有19例、82例、29例。(2)单因素分析结果显示,年龄、BMI、重大精神打击史、多发病灶、入院NIHSS评分是影响PSD发生的可能危险因素。进一步行Logistic多因素分析发现,仅多发病灶、入院NIHSS评分是影响PSD发病的独立性危险因素。(3)神经功能和认知功能评价结果显示,与非PSD组患者相比,PSD组患者NIHSS评分明显较高(P=0.000),而BI评分、MMSE评分显著较低(P=0.000),认知损害的发生率也明显较高。结论:首次急性脑梗死患者PSD的发生率较高,以中度抑郁为主,同时会伴有不同程度的神经功能缺损与认知功能障碍。多发病灶、入院NIHSS评分是影响PSD发生的最主要危险因素。Objective：To investigate the risk factors of post-stroke depression in patients with first acute cerebral infarction.Methods：The clinical data of 360 cases of patients with acute cerebral infarction from October 2014 to April2017 from the Department of Neurology of the No.254 Hospital of PLA were collected,using the DSM-V standard,carries on the diagnosis of patients with post-stroke depression,were divided into PSD group and non-PSD group.Single factor analysis and Logistic risk model were used to analyze the risk factors.Results：（1）There were 130 cases of PSD in 360 patients,the incidence rate was 36.1%.After the onset of 7 d,14 d,3 months,6 months,1 year,15 cases were confirmed,26 cases,35 cases,24 cases,30 cases.According to HAMD score,130 cases of PSD patients,mild group,moderate group and severe group were 19 cases,82 cases,29 cases.（2）Single factor analysis showed that age,BMI,major mental attack history,multiple lesions and NIHSS score were the possible risk factors for PSD.Further Logistic multivariate analysis revealed that only multiple lesions and admission NIHSS scores were independent risk factors for the onset of PSD.（3）Neurological and cognitive function evaluation results show that,compared with non PSD group,PSD group of patients with NIHSS score was significantly higher（P=0.000）,BI score,MMSE score was significantly lower（P=0.000）,the incidence of cognitive impairment was significantly higher.Conclusion：The incidence of PSD is higher in patients with acute cerebral infarction for the first time,mainly with moderate depression,accompanied by varying degrees of neurological impairment and cognitive impairment.Multiple lesions and NIHSS score were the most important risk factors for PSD.

关 键 词：急性脑梗死 卒中后抑郁 危险因素 

分 类 号：R749.1[医药卫生—神经病学与精神病学]