卒中后抑郁症状与脑梗死部位和日常生活活动能力的关系

目的探讨急性脑梗死患者卒中后抑郁（post-stroke depression，PSD）的发生与梗死部位和日常生活活动能力的关系。方法将178例脑梗死患者根据抑郁症诊断标准分为PSD组76例和非PSD组102例，以HAMILTON抑郁量表和日常生活活动能力量表（Barthel index，BI）进行评价，分析不同发病部位PSD的发生情况和PSD与BI的关系。结果PSD组和非PSD组中，多发性梗死分别为38例（50．0％）和21例（20．6％），Χ^2=17．004，P=0．000；额颞顶叶皮质区梗死13例（17．1％）和20例（19．6％），Χ^2=5．360，P=0．021；枕叶皮质区为1例（1．3％）和8例（7．8％），Χ^2=9．068，P=0．003；基底核区为14例（18．4％）和26例（25．5％），Χ^2=8．267，P=0．004；放射冠区为4例（5．3％）和13例（12．7％），Χ^2=8．920，P=0．003；脑干及小脑为6例（7．9％）和14例（14．7％），Χ^2=7．166，P=0．007；两组BI评分〈60分者分别为49例（64．5％）和38例（37．2％），BI评分≥60分者27例（35．5％）和64例（62．8％），Χ^2=12．913，P=0．000。左右大脑半球两侧差异无统计学意义，Χ^2=0．081，P=0．776。结论多发性脑梗死、额颞顶叶梗死、基底核梗死时，PSD发生率较高。脑梗死后日常生活能力越差，PSD发生率就越高。

Relationship between post-stroke depression and infarcted brain focus and activities of daily living

Objective To investigate the relationship between the occurrence of post-stroke depression （PSD） and infarcted brain focus and activities of daily living in patient with acute cerebral infarction. Methods Using a prospective design, 178 patients with acute cerebral infraction were divided into PSD （ n = 76 ） and non-PSD （ n = 102 ） groups according to the depression diagnostic criteria. The patients were evaluated by the Hamilton Depression Rating Scale （HAMD） and the Activities of Daily Living Scale to analyze the relationship of PSD with different focus of infarction and the activities of daily living. Results In the PSD and non-PSD groups, 38 （50. 0% ） and 21 （20. 6% ） patients had multiple focus of cerebral infarctions, respectively （Χ^2= 17. 004,P =0. 000） ; 13（ 17. 1% ） and 20 （ 19. 6% ） patients had frontal-temporal-parietal cortex infarction （Χ^2= 5. 360,P = 0. 021 ） ; 1 （ 1. 3% ） and 8 （7. 84% ） patients had occipital lobe lesion （Χ^2= 9. 068, P = 0. 003 ） ; 14 （ 18.4% ） and 26 （25.5%） patients had basal nucleus lesion（Χ^2 = 8. 267,P = 0. 004） ; 4（5. 3% ） and 13 （ 12. 7% ） patients had corona radiata lesion （Χ^2=8. 920,P = 0. 003 ） ; 6 （7.9%） and 14 （ 14. 7% ） patients had brain stem and cerebellum lesion （Χ^2 =7. 166, P =0.007）. The patients whose BI scores 〈60 were 49 （64.5%） and 38 （37.2%） patients, and the patients whose BI scores ≥ 60 were 27 （35.5%） and 64 （ 62. 8% ） patients （Χ^2 = 12. 913 ,P =0. 000）, respectively. There were no significant difference between the two hemispheres （Χ^2 = 0.081,P=0.776）. Conclusion The incidence of PSD is higher in the multiple infarction, frontal- temporal-parietal infarction and basal ganglia infarction. The poorer the hving ability after cerebral infarction, the higher the incidence of the PSD.