脑梗死患者康复科住院期间卒中后抑郁程度的相关因素

doi:10.3969/j.issn.1006-9771.2024.02.012

Abstract

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

CLC Number:

R743.3

LI Fang, LIU Huizhen, MEI Liping, ZHANG Tong, ZHANG Haojie, LI Bingjie, ZHAO Jun. Related factors of post-stroke depression in patients with cerebral infarction during hospitalization in rehabilitation department[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 217-222.

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References 26

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项目	低HAMD组 (n = 103)	高HAMD组 (n = 166)	t/χ²值	P值	项目	低HAMD组 (n = 103)	高HAMD组 (n = 166)	t/χ²值	P值
性别/n			0.234	0.629	学历/n			2.733	0.435
男	73	113			文盲	0	3
女	30	53			小学	6	10
年龄/岁	58.86±12.194	59.96±11.642	0.740	0.460	中学	52	91
婚姻/n			2.776	0.427	大专及以上	45	62
未婚	6	5			病程/d	66.777±88.951	52.600±50.982	1.475	0.143
已婚	89	145
丧偶	2	8
离异	6	8

项目	低HAMD组 (n = 103)	高HAMD组 (n = 166)	χ²值	P值	项目	低HAMD组 (n = 103)	高HAMD组 (n = 166)	χ²值	P值
病灶位置			1.940	0.379	失眠			2.744	0.098
颈内动脉供血系统	84	131			无	67	91
椎基底动脉供血系统	19	32			有	36	75
前后循环系统均有	0	3			便秘			5.892	0.015
偏瘫侧			2.771	0.428	无	59	119
右	41	75			有	44	47
左	50	79			吞咽障碍			15.675	< 0.001
双侧	8	10			无	72	75
无	4	2			有	31	91
感觉障碍			3.620	0.057	肩手综合征			5.379	0.020
无	48	58			无	52	60
有	55	108			有	51	106
失语			0.016	0.898
无	61	97
有	42	69

组别	n	髂腰肌	股四头肌
低HAMD组	103	3(2.00, 4.00)	3(3.00, 4.00)
高HAMD组	166	3(2.00, 4.50)	3(2.00, 4.00)
Z值		-2.020	-2.378
P值		0.043	0.017

组别	n	上肢	手	下肢
低HAMD组	103	2.99(2.22, 4.39)	2.90(1.91, 4.54)	3.72(2.77, 4.70)
高HAMD组	166	2.81(2.00, 3.97)	2.49(1.62, 4.05)	3.24(2.34, 4.32)
Z值		-1.707	-2.143	-2.651
P值		0.088	0.032	0.008

组别	n	NIHSS	MMSE	FMA	FMA-B	MBI
低HAMD组	103	6.92±4.11	22.18±8.098	43.50±30.45	6.84±3.86	49.17±23.75
高HAMD组	166	8.31±4.39	19.75±10.054	35.05±28.181	5.58±4.09	42.51±24.93
t值		2.579	2.184	2.315	2.503	2.171
P值		0.010	0.030	0.021	0.013	0.031

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

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相关因素	β	SE	Wald	P值	OR值	95%CI
便秘	-0.833	0.282	8.713	0.003	0.435	0.250~0.756
股四头肌肌力	-0.246	0.103	5.686	0.017	0.782	0.638~0.957
吞咽障碍	0.956	0.279	11.780	< 0.001	2.602	1.507~4.492
常量	1.003	0.688	2.123	0.145	2.726

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