脑卒中急性期并发抑郁状态临床特点及治疗观察

目的探讨脑卒中急性期并发抑郁状态的临床特点和治疗原则。方法回顾分析88例脑卒中急性期并发抑郁状态患者的主要临床特点,并观察百优解治疗2周、4周时的疗效。结果脑卒中急性期并发抑郁状态的发生率为26.0%(132507),其中多次卒中患者抑郁状态的发病率(46.9%)明显高于首次发病的患者(21.0%)(P<0.01)。病灶主要位于左半球的例数是右半球的2.95倍(6522)。位于半球前部的例数是后部的1.90倍(5730)。入组的88例,轻度抑郁68例(77.3%),中度抑郁14例(15.9%),重度抑郁6例(6.8%)。百优解结合心理治疗2周时汉密尔顿抑郁量表(HAMD)评分较治疗前有显著下降(P<0.05);4周时HAMD评分较2周时进一步下降(P<0.01)。结论脑卒中急性期抑郁状态发生率较高,多次卒中患者更加明显,病灶多位于左半球及半球的前部。积极抗抑郁治疗不但能使抑郁症状得到很大地改善,而且能促进卒中后神经功能的恢复。

The clinical characteristics and observation of therapeutic effect in patients with cerebral stroke at acute period complicated with depression

Objective To investigate the clinical features and treatment principles in patients with cerebral stroke at acute period complicated with depression.Methods The clinical manifestations and curative effect by Fluoxetine in 88 patients were retrospectively analyzed and summarized.Results The occurrence rate of cerebral stroke at acute period complicated with depression was 26.0% (132/507), the occurrence rate of multiple cerebral stroke was significantly higher than that of initial stroke (46.9% vs 21.0% P<0.01). The patients with left hemisphere lesions were 2.95 (65/22) times as many as those with right hemisphere lesion. The patients with the anterior lesions were 1.90 (57/30) times as many as those with the posterior lesions. Among 88 patients, mild depression cases were 68 (77.3%), moderate cases were 14(15.9%) and severe cases were 6(6.8%)respectively. After 2-week's treatment by Fluoxetine combined with psychological therapy the patients' HAMD score was obviously decreased,as compared with that before treatment (P<0.05);after 4-week's treatment,HAMD score was further decreased ,as compared with that of 2-week's (P<0.01).Conclusion The occurrence rate of cerebral stroke at acute period complicated with depression is higher,especially in the patients with multiple cerebral stroke.The stroke lesions are mainly located in the left hemisphere and the anterior of hemispheres. Positive treatment of post-stroke depression doesn't only to improve the symptoms of depression but also to promote the recovery of nervous function.