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1.
目的探讨缺血性脑卒中患者美国国立卫生研究院卒中量表(NIHSS)评分与卒中后抑郁(PSD)的相关性。方法选择2017-10—2018-10期间在湖南省脑科医院就诊的缺血性脑卒中患者150例,收集病史资料及NIHSS评分,并跟踪观察1个月,以中国精神障碍诊断和分类标准第3版(CCMD-3)的抑郁诊断标准诊断PSD,采用汉密尔顿抑郁量表(HAMD,17项版本)评估抑郁症状的严重程度。将研究对象分为非PSD组(HAMD评分≤6分)和PSD组(HAMD评分7分),再将PSD组进一步分为轻度抑郁亚组(HAMD评分7分且≤16分)、中-重度抑郁症亚组(HAMD评分≥17分)。计算PSD患病率,并分析影响PSD患病率的相关因素(性别、高血压、糖尿病、高血脂、房颤、吸烟、饮酒、既往有无脑卒中史),以及抑郁症状的严重程度(HAMD评分)与NIHSS评分的相关性。结果缺血性脑卒中后1个月内PSD的患病率为34.0%(51例),其中轻度抑郁症状患者占64.7%(33例)。PSD组既往脑卒中史的构成比(83.3%)显著高于非PSD组(30.3%;P0.05)。PSD组NIHSS评分与HAMD评分具有相关性(OR=5.231,95%CI=1.204~10.154,P=0.01)。结论 PSD以轻度抑郁症状为主,既往有脑卒中病史者患病率高,且NIHSS评分与抑郁症状的严重程度具有相关性,NIHSS评分越高,PSD患病几率越大。  相似文献   

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目的研究脑卒中后患者抑郁(PSD)发生状况以及严重程度的演变规律。方法选取连续收治的符合入组标准的48例缺血性脑卒中住院患者进行16周随访研究,于脑卒中后1周行神经功能缺损量表(NIHSS)、Barthel指数(BI)、社会支持评定量表(SSRS)评估患者神经功能缺损程度、日常生活活动能力以及社会支持情况。脑卒中后1、2、4、8、12和16周分别行汉密尔顿抑郁量表(HAMDS)评估患者抑郁情况,根据不同时间点的HAMDS评分动态判定患者是否为PSD,并据此分为PSD组和非PSD组。结果脑卒中后2周PSD发生率(52.1%)达峰值,之后呈下降趋势。PSD患者第2周HAMD评分达峰值平均(15.14±4.28)分,之后逐渐下降,第16周降至(10.00±2.20)分。脑卒中后1周PSD (HAMDS评分≥8分)组为24例(50%),脑卒中后1周PSD组NIHSS评分显著高于非PSD组,BI指数、SSRS评分显著低于非PSD组,差异均有统计学意义(均P0.05);HAMDS评分与NIHSS评分呈正相关,与BI、SSRS评分呈负相关(P0.05)。结论经16周随访发现,PSD发生状况及严重程度呈动态变化过程;PSD的发生与神经功能缺损、日常生活活动能力、社会支持有密切关系。  相似文献   

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目的 探讨脑卒中急性期患者卒中后抑郁(PSD)的发生率及其危险因素.方法 连续入组的发病24 h内入院的急性脑卒中患者127例,根据入院14 d内汉密尔顿抑郁量表(17项)和蒙哥马利抑郁量表评分分为PSD组和非PSD组,分析PSD与性别、婚姻状况、年龄、文化程度、卒中类型、病灶部位、脑梗死容积、高血压、糖尿病、冠心病、吸烟、饮酒、体质量指数(BMI)、卒中家族史、卒中病史、颈动脉斑块、美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)和简易精神状态检查(MMSE)量表评分等临床因素的关系.结果 本组PSD发生率为37.0%(47例).PSD组脑梗死比率、伴高血压病比率、脑梗死容积、入院时NIHSS评分均明显高于非PSD组,BI和MMSE评分均明显低于非PSD组(P<0.05~0.01).多因素Logistic回归分析显示脑梗死、高血压和入院时BI与PSD独立相关(OR=5.084,95%CI:1.255~20.592,P=0.023;OR=4.846,95%CI:1.447~16.225,P=0.010;OR=0.966,95%CI:0.951~0.981,P<0.001).结论 脑卒中急性期患者PSD的发生率较高,脑梗死、高血压和入院时BI是PSD的独立危险因素.  相似文献   

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西酞普兰对急性脑卒中后抑郁患者神经功能恢复的影响   总被引:5,自引:0,他引:5  
目的研究西酞普兰对急性卒中后患者抑郁状态、日常生活活动能力和神经功能缺损程度的影响。方法根据汉密顿抑郁量表(HAMD)将卒中后抑郁患者86例随机分为治疗组和对照组,全部病例均进行常规药物治疗和康复训练,治疗组加用西酞普兰20mg口服,1次/d。所有患者在治疗前和治疗后4周用HAMD、Barthel指数(BI)、神经功能缺损程度量表(CSS)进行评分。结果治疗组治疗后HAMD评分、CSS评分均较治疗前显著下降(P<0.05),且明显低于对照组治疗后(P<0.05)。治疗组治疗后BI较治疗前显著升高(P<0.05),且明显高于对照组治疗后(P<0.05)。结论PSD脑卒中患者早期恢复有明显负面影响。西酞普兰能明显改善PSD患者抑郁状态,促进日常生活活动能力和神经功能的恢复。  相似文献   

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目的探讨急性缺血性卒中后抑郁(PSD)的发生率及其相关危险因素。方法 185例经CT或MRI证实的急性缺血性卒中患者根据精神障碍诊断和统计手册第5版(DSM-V)标准和24项Hamilton抑郁量表(HAMD)评分分为PSD组和non-PSD组;分析PSD社会人口学资料、血管危险因素、相关生化指标、NIHSS、Barthel指数(BI)、MMSE等相关因素对PSD的影响。结果本组PSD发生率为40.54%(75例),主要以轻、中度抑郁为主;与non-PSD组比较,PSD组患者糖尿病发生率高(P=0.044),神经功能缺损程度重、日常生活活动能力差(P=0.000,P=0.001),MMSE评分降低(P=0.000),而超敏C-反应蛋白(hs-CRP)和同型半胱氨酸(Hcy)水平升高(P=0.000,P=0.006);其中BI、MMSE评分与HAMD评分呈负相关(均P0.05),而NIHSS评分、hs-CRP和Hcy与HAMD评分呈正相关(均P0.05);Logistic回归分析提示,低MMSE评分、高NIHSS评分及高hs-CRP和Hcy水平可能是急性缺血性PSD的独立危险因素。结论 PSD主要以轻、中度抑郁为主;PSD与糖尿病病史、认知功能障碍、神经功能缺损程度、hs-CRP和Hcy水平密切相关。  相似文献   

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目的调查脑卒中患者卒中恢复期血清BDNF含量与卒中后抑郁发生的相关性。方法选择住院确诊为急性脑卒中患者76例,男45例,女31例;年龄34~82岁,平均57.64岁;脑梗死43例,脑出血33例。于病程2周后采用17项版本的汉密尔顿抑郁量表(HAMD)对入组患者进行抑郁程度评分,并用酶联免疫吸附实验(ELISA)法测定患者血清BDNF蛋白含量。根据量表测评结果将入组患者分为脑卒中后抑郁组(PSD组)和脑卒中后非抑郁组(非PSD组)。结果本组患者中发生PSD 42例,卒中后抑郁的发生率为55.26%,其中轻度抑郁30例(39.47%),中度抑郁患者8例(10.53%),重度抑郁患者4例(5.26%);非PSD组34例。Wilcoxon秩和检验结果提示PSD组患者血清BDNF含量较非PSD组患者明显降低(P<0.001)。直线相关分析结果发现,脑卒中恢复期患者血清BDNF含量的表达变化与脑卒中后抑郁程度呈负相关关系,Pearson相关系数为-0.347,P=0.024(双侧)。结论脑卒中后抑郁患者在脑卒中恢复期血清BDNF含量显著降低,且脑卒中后抑郁程度与脑卒中恢复期血清BDNF含量呈负相关关系。提示脑卒中患者血清BDNF含量在预示脑卒中后抑郁的发生及病情严重程度等方面可能发挥了重要作用。  相似文献   

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路优泰对脑卒中后抑郁及神经功能康复的影响   总被引:8,自引:1,他引:7  
目的 观察路优泰对脑卒中后抑郁的治疗效果,及其对患者神经功能康复及生活质量的影响.方法 90例诊断为脑卒中后抑郁的患者随机分为治疗组45例和对照组45例,治疗组给予口服路优泰,同时给予改善脑部血液供应、营养神经细胞及常规康复治疗;对照组给予心理治疗,其余治疗同治疗组.采用汉密顿抑郁量表(HAMD)、日常生活活动量表Barthel指数(BI)及生活质量指数量表评分,观察患者治疗前后抑郁状态、日常生活活动能力及生活质量变化情况.结果 与治疗前比较,治疗组在治疗4周、8周后,HAMD、BI评分及生活质量量表评分具有显著差异(P<0.05), 与对照组比较,治疗组治疗4周、8周后,HAMD、BI评分评分具有统计学意义(P<0.05).结论 路优泰对卒中后抑郁状态、日常生活活动能力均有改善作用,并提高脑卒中患者的生活质量.  相似文献   

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目的探讨卒中后抑郁(PSD)的相关因素。方法采用汉密尔顿抑郁量表(HAMD)在卒中后14 d及90 d对300例脑卒中患者进行评分,并据此分为PSD组及非PSD组,对两组间的卒中部位、美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表评分(mRS)及简易精神状态检查表(MMSE)评分进行比较。结果 140例(46.7%)患者发生PSD;卒中灶多发或位于左侧半球、额颞叶及基底节的患者PSD发生率明显高于卒中灶单发、位于右侧半球、顶枕叶及皮质的患者(均P<0.05);PSD组发病14 d时NIHSS评分、发病14 d及90 d时mRS评分明显高于非PSD组(P<0.05~0.01)。结论 PSD发生与多灶性卒中及卒中灶位于左侧半球、额颞叶、基底节区有关;且与卒中后神经功能缺损程度及残疾程度有关。  相似文献   

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目的对比帕罗西汀与阿米替林治疗脑卒中后抑郁、神经功能康复的疗效。方法 59例脑卒中后抑郁患者随机分为2组,抑郁评分采用汉密尔顿抑郁量表(HAMD)在2组治疗前及治疗后2、4、8周末评分,神经功能康复采用斯堪的纳维亚卒中量表(SSS)及日常生活能力Barthel指数(BI)在2组治疗前后评分。结果治疗2、4、8周末帕罗西汀组HAMD评分与对照组比较有显著性差异(P0.01);治疗后帕罗西汀组SSS、BI评分均明显增加,与对照组相比有显著性差异(P0.01)。结论帕罗西汀对脑卒中后抑郁、神经功能康复的疗效优于阿米替林。  相似文献   

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目的 探讨卒中后抑郁/焦虑对卒中患者日常生活能力和神经功能康复的影响,以及帕罗西汀联合早期心理干预的临床疗效。方法 采用抑郁自评量表(SDS)、焦虑自评量表(SAS)对272例脑卒中患者进行抑郁/焦虑状态评定,其中患有卒中后抑郁并发焦虑的81名患者随机分成3组,分别接受单用帕罗西汀治疗、帕罗西汀联合心理治疗以及不干预。采用斯堪的那维亚脑卒中量表(SSS)、Barthel指数(BI)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评测治疗前后的疗效。结果 急性脑卒中患者卒中后抑郁并焦虑患病率为29.78%,抑郁与焦虑共病率为65.85%,额叶、左侧大脑半球、基底节病灶与卒中后抑郁/焦虑的发生相关(额叶P <0.05、左侧大脑半球P <0.0001、基底节P <0.0001);治疗组I和治疗组II HAMD、HAMA、SSS评分减少和BI评分增加与对照组比较均有显著性差异(P均<0.01),治疗组II HAMD、HAMA、SSS评分减少和BI评分增加较治疗组I有显著性差异(P均<0.05)。结论 卒中后抑郁/焦虑的发生与脑卒中部位相关;卒中后抑郁/焦虑障碍明显降低患者神经功能康复程度和生活能力恢复;对卒中后抑郁/焦虑患者单用药物帕罗西汀或给予帕罗西汀联合心理干预治疗均能提高患者神经功能康复程度和生活能力恢复,而且帕罗西汀联合心理干预治疗疗效更满意  相似文献   

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A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.  相似文献   

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Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.  相似文献   

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Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.  相似文献   

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Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005  相似文献   

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After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.  相似文献   

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