脑卒中后康复阶段抑郁的危险因素分析
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摘要
目的:研究脑卒中后康复阶段抑郁的发生率及相关危险因素,确定该阶段需要关注的脑卒中后抑郁症状群。方法:横断面调查2017年3月至2018年1月于两家三甲医院康复科治疗的126名脑卒中住院患者的病例资料,采用抑郁自评量表(self-rating depression scale,SDS)评估患者的抑郁症状,分析其影响因素。结果:单因素和多因素分析结果显示,美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分(OR=1.530,P=0.000,95%CI=1.229～1.904)、匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评分(OR=1.249,P=0.004,95%CI=1.073～1.454)、疼痛评分(visual analogue scale,VAS)(OR=1.839,P=0.018,95%CI=1.111～3.045)、收入(OR=6.364,P=0.007,95%CI=1.670～24.249)、照护者(OR=5.269,P=0.015,95%CI=1.384～20.058)是康复阶段脑卒中患者抑郁发生的独立危险因素。结论:脑卒中患者在康复阶段,疼痛程度越严重,NIHSS与PSQI评分越高,收入不足并且由职业陪护照顾时,越容易发生脑卒中后抑郁。
Objective:To investigate the incidence rate of post-stroke depression(PSD)in rehabilitation stage and related risk factors,as well as the symptoms of PSD which should be taken seriously in this stage. Methods:A cross-sectional survey was performed among126 patients with stroke who were treated in Department of Rehabilitation Medicine in two grade A tertiary hospitals from March 2017 to January 2018. The Self-rating depression scale was used to evaluate the symptoms of depression,and related influencing factors were analyzed. Results:The univariate and multivariate analyses showed that National Institute of Health stroke scale(NIHSS)score[odds ratio(OR)=1.530,95% confidence interval(CI)=1.229-1.904,P=0.000],Pittsburgh sleep quality index(PSQI)score(OR=1.249,95%CI=1.073 to 1.454,P=0.004),Visual Analogue Scale(VAS)score(OR=1.839,95%CI=1.111 to 3.045,P=0.018),income(OR=6.364,95%CI=1.670 to 24.249,P=0.007),and caregiver(OR=5.269,95%CI=1.384 to 20.058,P=0.015)were independent risk factors for depression in patients with stroke in rehabilitation stage. Conclusion:The patients with stroke who have higher NIHSS,PSQI,and VAS scores and a lower level of income and are taken care of by professional caregivers in rehabilitation phase are more likely to develop PSD.
Objective:To investigate the incidence rate of post-stroke depression(PSD)in rehabilitation stage and related risk factors,as well as the symptoms of PSD which should be taken seriously in this stage. Methods:A cross-sectional survey was performed among126 patients with stroke who were treated in Department of Rehabilitation Medicine in two grade A tertiary hospitals from March 2017 to January 2018. The Self-rating depression scale was used to evaluate the symptoms of depression,and related influencing factors were analyzed. Results:The univariate and multivariate analyses showed that National Institute of Health stroke scale(NIHSS)score[odds ratio(OR)=1.530,95% confidence interval(CI)=1.229-1.904,P=0.000],Pittsburgh sleep quality index(PSQI)score(OR=1.249,95%CI=1.073 to 1.454,P=0.004),Visual Analogue Scale(VAS)score(OR=1.839,95%CI=1.111 to 3.045,P=0.018),income(OR=6.364,95%CI=1.670 to 24.249,P=0.007),and caregiver(OR=5.269,95%CI=1.384 to 20.058,P=0.015)were independent risk factors for depression in patients with stroke in rehabilitation stage. Conclusion:The patients with stroke who have higher NIHSS,PSQI,and VAS scores and a lower level of income and are taken care of by professional caregivers in rehabilitation phase are more likely to develop PSD.
引文
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[2]Lam SC,Lee LY,To KW.Depressive symptoms among community-dwelling,post-stroke elders in Hong Kong[J].Int Nurs Rev,2010,57(2):269-273.
[3]Bartoli F,Lillia N,Lax A,et al.Depression after stroke and risk of mortality:a systematic review and meta-analysis[J].Stroke Res Treat,2013,2013:862978.
[4]Ayerbe L,Ayis S,Crichton SL,et al.Explanatory factors for the increased mortality of stroke patients with depression[J].Neurology,2014,83(22):2007-2012.
[5]Wang Z,Zhu M,Su Z,et al.Post-stroke depression:different characteristics based on follow-up stage and gender-a cohort perspective study from Mainland China[J].Neurol Res,2017,39(11):996-1005.
[6]Sun N,Li QJ,Lv DM,et al.A survey on 465 patients with poststroke depression in China[J].Arch Psychiatr Nurs,2014,28(6):368-371.
[7]Fei K,Benn EK,Negron R,et al.Prevalence of depression among stroke survivors:racial-ethnic differences[J].Stroke,2016,47(2):512-515.
[8]Kaadan MI,Larson MJ.Management of post-stroke depression in the Middle East and North Africa:too little is known[J].J Neurol Sci,2017,378:220-224.
[9]Ayerbe L,Ayis S,Crichton S,et al.The natural history of depression up to 15 years after stroke the South London Stroke Register[J].Stroke,2013,44(4):1105-1110.
[10]Ilut S,Stan A,Blesneag A,et al.Factors that influence the severity of post-stroke depression[J].J Med Life,2017,10(3):167-171.
[11]张璟,王兰桂,铁婷婷,等.高原地区急性期脑卒中后抑郁的危险因素分析[J].中华老年心脑血管病杂志,2017,19(2):171-174.
[12]Okajima I,Komada Y,Nomura T,et al.Insomnia as a risk for depression:a longitudinal epidemiologic study on a Japanese rural cohort[J].J Clin Psychiatry,2012,73(3):377-383.
[13]Klumpp H,Roberts J,Kapella M,et al.Subjective and objective sleep quality modulate emotion regulatory brain function in anxiety and depression[J].Depress Anxiety,201,34(7):651-660.
[14]Motomura Y,Kitamura S,Oba K,et al.Sleep debt elicits negative emotional reaction through diminished amygdala-anterior cingulate functional connectivity[J].PLoS One,2013,8(2):e56578.
[15]O’Donnell MJ,Diener HC,Sacco RL,et al.Chronic pain syndromes after ischemic stroke:profess trial[J].Stroke,2013,44(5):1238-1243.
[16]Roosink M,Renzenbrink GJ,Buitenweg JR,et al.Persistent shoulder pain in the first 6 months after stroke:results of a prospective cohort study[J].Arch Phys Med Rehabil,2011,92(7):1139-1145.
[17]William R,Minella C,Francesco M,et al.Population-based study of central post-stroke pain in Rimini district,Italy[J].J Pain Res,2013,6:705-711.
[18]Winstein C,Stein J,Arena R,et al.Guidelines for adult stroke rehabilitation and recovery:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2016,47(6):e98-169.
[19]Park EY,Kim JH.An analysis of depressive symptoms in stroke survivors:verification of a moderating effect of demographic characteristics[J].BMC Psychiatry,2017,17(1):132.
[20]Shi Y,Yang D,Zeng Y,et al.Risk factors for post-stroke depression:a meta-analysis[J].Front Aging Neurosci,2017,9:218.