《中国康复理论与实践》

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (2): 217-222.doi: 10.3969/j.issn.1006-9771.2024.02.012

• 应用研究 • 上一篇    下一篇

脑梗死患者康复科住院期间卒中后抑郁程度的相关因素

李芳1a,2, 刘慧珍1b, 梅利平1c,2, 张通1a,2(), 张豪杰2, 李冰洁1c,2, 赵军1c,2   

  1. 1.中国康复研究中心北京博爱医院，a.重症康复科;b.急诊科;c.神经内科，北京市 100068
    2.首都医科大学康复医学院，北京市 100068
  • 收稿日期:2023-04-02 修回日期:2023-08-19 出版日期:2024-02-25 发布日期:2024-03-01
  • 通讯作者: 张通 E-mail:tom611@126.com
  • 作者简介:李芳(1986-)，女，汉族，河南新乡市人，博士，主治医师，主要研究方向：神经康复。
  • 基金资助:
    中国康复研究中心基金项目(2018ZX-Q6);中国康复研究中心基金项目(2019ZX-Q4);中国康复研究中心基金项目(2023YJZ-12)

Related factors of post-stroke depression in patients with cerebral infarction during hospitalization in rehabilitation department

LI Fang1a,2, LIU Huizhen1b, MEI Liping1c,2, ZHANG Tong1a,2(), ZHANG Haojie2, LI Bingjie1c,2, ZHAO Jun1c,2   

  1. 1a. Department of Intensive Care Unit; b. Department of Emergency; c. Department of Neurology, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
    2. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
  • Received:2023-04-02 Revised:2023-08-19 Published:2024-02-25 Online:2024-03-01
  • Contact: ZHANG Tong E-mail:tom611@126.com
  • Supported by:
    China Rehabilitation Research Center Research Project(2018ZX-Q6);China Rehabilitation Research Center Research Project(2019ZX-Q4);China Rehabilitation Research Center Research Project(2023YJZ-12)

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摘要：

目的 探讨脑梗死患者在康复科住院期间发生卒中后抑郁的相关危险因素。
方法 回顾性分析2019年12月至2023年2月在北京博爱医院住院、曾诊断为抑郁状态且经心理科会诊的脑梗死患者，统计一般资料(性别、年龄、学历、婚姻)，疾病特征(病程、病灶位置、偏瘫侧别、感觉障碍、失语、失眠、吞咽障碍、肩手综合征、便秘)，运动功能(偏瘫侧肌力、Brunnstrom分期)，简易精神状态检查(MMSE)、美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer评定量表(FMA)、Fugl-Meyer评定量表-平衡(FMA-B)、改良Barthel指数(MBI)、汉密尔顿抑郁量表(HAMD)评分等资料。HAMD ≤ 20分的患者入低HAMD组，HAMD > 20分的患者入高HAMD组。
结果 在2 403例脑梗死患者中，诊断为抑郁状态且经心理科会诊的患者269例，低HAMD组103例，高HAMD组166例。高HAMD组便秘发生率较低，吞咽障碍、肩手综合征发生率较高(χ2 > 5.379, P < 0.05);髂腰肌、股四头肌肌力，下肢和手Brunnstrom分期，NIHSS、MMSE、FMA、FMA-B、MBI评分差于低HAMD组(|Z| > 2.020, t > 2.171, P < 0.05)。Logistic回归分析显示，便秘(OR = 0.435)、股四头肌肌力(OR = 0.782)、吞咽障碍(OR = 2.602)是康复期患者发生卒中后抑郁的相关因素(P < 0.05)。
结论 卒中后吞咽障碍和肌力下降，可能加重卒中后抑郁。便秘可能并不加重卒中后抑郁程度。

关键词: 脑梗死, 卒中后抑郁, 康复, 功能障碍, 相关因素

Abstract:

Object To explore the risk factors related to the intensity of post-stroke depression in patients with cerebral infarction during hospitalization in the rehabilitation department.
Methods The hospital consultation records of cerebral infarction patients in Beijing Bo'ai Hospital from December, 2019 to February, 2023 were reviewed from the hospital information system, and those who were diagnosed as depression visited the department of psychology were selected. It was collected including general information of sexes, ages, education levels, matrimony; medical features of course, location, affected side, sensory disorders, aphasia, agrypnia, dysphagia, hand-shoulder syndrome, constipation; functioning of muscle strength and Brunnstrom stages; and scores of Mini-Mental State Examination (MMSE), National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA), Fugl-Meyer Assessment-Balance (FMA-B), modified Barthel Index (MBI) and Hamilton Depression Scale (HAMD). Patients with HAMD scores ≤ 20 were as the low group, and those > 20 were as the high group.
Result A total of 2 403 hospitalized stroke patients were included, out of which 269 patients with cerebral infarction were diagnosed as depression and visited the department of psychology; while 103 cases were in the low group and 166 cases were in the high group. The incidence of constipation was less, and the incidence of dysphagia and shoulder-hand syndrome was higher in the high group (χ2 > 5.379, P < 0.05), with weaker strength of iliopsoas muscle and quadriceps muscle, earlier of Brunnstrom stage of lower extremities and hands, and worse scores of NIHSS, MMSE, FMA, FMA-B and MBI (|Z| > 2.020, t > 2.171, P < 0.05). Logistic regression showed that constipation (OR = 0.435), quadriceps muscle strength (OR = 0.782) and dysphagia (OR = 2.602) related to the intensity of post-stroke depression in convalescent patients (P < 0.05).
Conclusion Post-stroke dysphagia and poor quadriceps muscle strength may exacerbate post-stroke depression; however, constipation may not.

Key words: cerebral infarction, post-stroke depression, rehabilitation, dysfunction, related factors

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