脑卒中后抑郁及其治疗对神经功能恢复的影响

背景脑卒中后抑郁(post-stroke depression,PSD)患者日常生活能力和社交活动障碍对神经功能恢复是否有影响?目的观察PSD的发生率和相关因素,探讨盐酸氟西汀(百优解)抗抑郁治疗对脑卒中后抑郁患者神经功能康复的影响.设计以诊断为依据的病例对照研究.地点和对象选自苏州大学附属第二医院2000-01/2002-03连续住院的急性脑卒中患者132例(脑梗死78例,脑出血54例),男79例,女53例,年龄48～87岁,平均(62.5±12.1)岁,受教育时间(5.2±4.5)年.方法在病程2周、1,3,6,12个月时对每一位人组患者行PSD诊断、神经功能缺损评分、日常生活能力(ADL)评分、汉密尔顿抑郁量表(HAMD)评分;同时完成Zung's抑郁自评量表(SDS)和焦虑自评量表(SAS).主要观察指标神经功能缺损,ADL,HAMD,SDS,SAS评分.结果①脑卒中患者中约44.7%出现抑郁症状.②脑卒中类型和性别与PSD发生率无相关性(P＞0.05).③PSD的发生率和严重程度与神经功能缺损和日常生活能力下降程度有关.④盐酸氟西汀能明显改善病程3,6个月时神经功能缺损,病程12个月时抑郁症状(4.63±2.37),日常生活能力(23.25±10.12),神经功能缺损(12.95±11.54)方面改善尤为显著,差异有显著性意义(t=2.016～12.174,P＜0.05).结论抗抑郁治疗能在抑郁症状明显改善的同时,促进患者日常生活能力和神经功能的恢复.

Impact of post-stroke depression and its therapy on neural function recovery

BACKGROUND: Whether there is an impact of functional disorder in the activity of daily living and social activity induced by post-stroke depression (PSD) on neural function recovery?OBJECTIVE: To observe the incidence of PSD and its relative factors for the investigation of the impact of Fluoxetine Hydrochloride(FH) against depression on the neural function recovery in PSD patients.DESIGN: A case control study based on diagnosis.SETTINGS and PARTICIPANTS: One hundred and thirty-two acute cerebralapoplexy patients including 78 cases of cerebral infarct and 54 cases of cerebral hemorrhage were selected from inpatient department of the Second Hospital affiliated to Suzhou University from January 2000 to March 2002, in which there were 79 males and 53 females aged from 48 to 87 years old with a mean age of (62.5 ± 12. 1) years old and education-received years of (5.2 ±4. 5) years.INTERVENTIONS: PSD diagnosis, nerve deficiency scale, activity of daily living scale(ADL), and Hamilton depression scale(HAMD) were conducted in every selected patient at 2-week, 1, 3, 6, and 12-month of the course of the disease and Zung' s self-rating depression scale(SDS) and self-rating anxiety scale(SAS) were completed by the patients simultaneously.MAIN OUTCOME MEASURES: Nerve deficiency, ADL, HAMD, SDS andSAS scores.cidence and severity of PSD correlated with nerve deficiency and the decrease 6-month of the course of disease and there were more significant improvements in depression(4.63 ±2.37), ADL(23.25 ± 10. 12), and nerve deficiency(12.95 ± 11.54) at 12-month of the course of disease( t = 2. 016 -12. 174, P ＜ 0. 05).CONCLUSION: Anti-depression therapy can improve ADL and neural function recovery in patients at the same time of significantly improving depressive symptoms.