脑卒中急性期血压监测及其与预后关系的临床研究

目的：探讨急性脑卒中中后动态血压变化及其与预后的关系。方法：由专人（同一人）负责对55例急性脑卒中患者进行了第1及第7天动态血压的监测，同时评定第1、第7天及第30天神经功能评分及病残程度分级。结果：脑卒中后增高的血压在7天后，在无特殊降压措施条件下，无论是随测血压，还是动态血压均自发下降，生活基本自理组（0－Ⅲ）和生活依赖组（Ⅳ－Ⅶ）脑卒中后增高的血压无明显差异性，结论：脑卒中急性期血压存在自发下降趋势，脑卒中急性期血压的治疗需采取慎重，合理，个体化治疗。     

急性脑卒中后抑郁焦虑的发生率及相关因素研究

目的 探讨急性脑卒中后抑郁、焦虑症状的发生率及相关因素。方法 采用SDS和SAS对389例急性脑卒中患者进行量表自评。结果 抑郁症状的发生率为39.6％、焦虑症状的发生率为41.6％,分析发现抑郁症状的发生与左侧大脑半球病变、病程>1个月及SAS评分高有关;而焦虑症状的发生则与左侧大脑半球病变、病程≤1个月及SDS评分高有关。结论 急性脑卒中患者存在明显的负性情绪障碍,应及早诊断和处理,以促进病人全面康复。     

Sleep disturbance and deficits of sustained attention following stroke

Objective: To simultaneously investigate the prevalence of and impact that the poststroke complications of daytime sleepiness, poor sleep quality, depression, and fatigue may be having upon deficits of sustained attention, as assessed using the Psychomotor Vigilance Task (PVT). Method: Twenty-two patients with stroke (mean age: 68.23 ± 12.17 years) and 20 healthy control participants (mean age: 68.1 ± 9.5 years) completed subjective measures of daytime sleepiness, sleep quality, fatigue, and depression and an objective measure of sustained attention as assessed using the PVT. Results: Patients with stroke compared to controls showed heightened levels of fatigue (p = .001, η² = .29) and depression (p = .002, η² = .23), plus greater deficits of sustained attention as reflected by poorer performance across all PVT outcome measures including: slower mean reaction times (p = .002, η² = .22); increased number of lapses (p = .002, η² = .24); and greater variability in reaction time (RT) responses (p = .016, η² = .15). Reaction time distribution analysis suggested that daytime sleepiness and sleep quality had little influence across PVT performance; however, depressive symptomology was associated with longer RT responses, indicative of inattention, and fatigue impacted upon the entire distribution of PVT responses. Conclusions: PVT performance illustrated significant deficits across the domain of sustained attention for patients with stroke in comparison to healthy controls, in terms of inattention as well as slower sensory–motor speed. The common poststroke complications of depressive symptomology and fatigue appear to be associated with these deficits in sustained attention, warranting further investigation.     

脑卒中后睡眠障碍相关因素分析

目的 探讨脑卒中患者睡眠障碍的临床情况及相关影响因素.方法 选取山东省东营市胜利油田中心医院神经内科自2005年1月至2010年6月收治的脑卒中患者204例,以匹兹堡睡眠质量指数量表(PSQI)判定是否睡眠障碍,比较不同性别、年龄、脑卒中部位患者的睡眠障碍发生率.通过症状自评量表(SCL-90)比较睡眠障碍和无睡眠障碍患者的身心健康状况,通过汉密尔顿抑郁量表(HAMD)、Barthel指数和美国国立卫生研究院卒中量表(NIHSS)评分比较睡眠障碍和无睡眠障碍患者抑郁、生活能力及神经功能缺损程度的差异.结果 本组患者睡眠障碍95例,发生率为46.6%(95/204).女性患者睡眠障碍发生率较高,差异有统计学意义(P＜0.05).≥70岁患者睡眠障碍发生率最高(57.6%),其次为＜50岁(41.5%)、50～69岁人群(32.9%),脑卒中发生在皮质下患者的睡眠障碍发生率最高(64.2%),其次为大脑皮质(27.4%)、小脑(4.5%),差异均有统计学意义(P＜0.05).卒中部位位于左半球患者睡眠障碍发生率明显高于右半球患者,差异有统计学意义(P＜0.05);与脑卒中后无睡眠障碍患者比较,脑卒中后睡眠障碍患者SCL-90 9项指标、HAMD评分及NIHSS评分均较高,而Barthel指数较低,差异均有统计学意义(P＜0.05).结论 脑卒中患者睡眠障碍发生率较高,并与性别、年龄、卒中部位有关,可导致抑郁、焦虑、神经功能缺损,生活质量下降,临床治疗过程中应积极做好护理工作.

Abstract：

Objective To explore the clinical features of sleep disorder in patients with stroke and its related factors. Methods Two hundred and four patients with stroke, admitted to our hospital from January 2005 to June 2010, were chosen; Pittsburgh Sleep Quality Index (PSQI) was employed to determine whether these patients had sleep disorder; the prevalences of sleep disorder in patients with different ages, genders and lesions of stroke were compared. Symptom Checklist-90 (SCL-90)questionnaire was used to compare the physical and mental conditions of patients with or without sleep disorder; Hamilton Depression Rating Scales (HAMD), Barthel index, and National Institutes of Health Stroke Scale (NIHSS) were employed to compare the differences of depression, viability and neurologic impairment in patients with or without sleep disorder. Results The prevalence of sleep disorder was 46.6% (95/204), and it was higher in female group (53.8% vs 38.8%; x2=3.851, P=0.033). Patients aged ≥70 years had the highest rate of sleep disorder (57.6%), followed by patients aged ＜50 years (41.5%),and then patients aged between 50 and 69 years showed the lowest rate (32.9%). The sites of stroke located in the subcortex, cortex, and cerebellum enjoyed their prevalences of 64.2%, 27.4% and 4.5%,respectively. The incidence of sleep disorder in patients with stroke located in the left hemisphere was obviously higher than that in the right hemisphere (x2=7.688, P=0.008). The results of 9 indexes of SCL-90, scores of HAMD and NIHSS in patients with sleep disorder were significantly higher than those in patients without sleep disorder, while the Barthel index was in the opposite position with obvious differences (P＜0.05). Conclusion High prevalence of sleep disorder in patients with stroke is noted,which is related to gender, age of the patients and the sites of stroke, and may lead to depression, anxiety,neurological functional deficit and decrease of life quality. And we should pay more attention to nursing care during all the treatment.     

Depressive feelings in children with narcolepsy

ObjectivesWe aimed to evaluate depressive feelings and their correlations in children and adolescents with narcolepsy collected in national reference centers for narcolepsy.MethodsWe compared clinical and sleep characteristics of patients with and without depressive symptoms evaluated on the Children’s Depression Inventory (CDI).ResultsOur study sample included 88 children (44 boys; 44 de novo patients) with a mean age of 11.9 ± 3.1 years at diagnosis (37.5% were aged ⩽10 years). Obesity was found in 59% of the sample and cataplexy was present in 80.7%. The DQB1*0602 allele was positive in 93.5% of our sample. There were 25% of children who had clinically depressive feelings (CDI > 16), especially girls older than the age of 10 years. Bivariate associations indicated that depressive feelings were associated with fatigue (48%), hyperactivity (31%), insomnia (16%), and excessive daytime sleepiness (EDS) (14–24%). In the multivariate model adjusted for gender and age, only fatigue explained the variability of the depression score.ConclusionIn our large cohort, high levels of depressive symptoms essentially expressed by fatigue affected 25% of children with narcolepsy. The girls older than 10 years of age were especially vulnerable. The similar prevalence of depressive feelings in treated vs never-treated patients suggests a specific need for diagnosing and managing this symptom in young patients with narcolepsy.     

脑卒中患者急性期发生抑郁的相关因素分析

目的探讨脑卒中患者急性期发生抑郁的相关因素。方法采用神经功能缺损评分(SSS)、日常生活能力评分(ADL)、汉密尔顿抑郁量表(HADM)及Zung’s抑郁自评量表(SDS)对134例急性脑卒中患者1月内进行测试,并进行相关性分析。结果卒中后抑郁(PSD)的发生率与卒中类型、年龄及性别无关;与患者运动功能障碍程度、病变部位呈正相关。结论脑卒中患者急性期抑郁发病率偏高,可能主要与内在因素、大脑功能及皮质下结构的损害有关。     

Depressive symptoms in persons with acute coronary syndrome: Specific symptom scales and prognosis

Objective

To determine which particular depressive symptom scales, derived from three scales, predicted poorer prognosis in persons with acute coronary syndrome (ACS).

Methods

Hospitalized ACS patients (n=408) completed questionnaires (depression, vital exhaustion). Mokken scaling derived unidimensional scales. Major cardiac events (cardiac mortality, ACS, unplanned revascularization) were assessed at median 67 weeks post event.

Results

Only depressive symptoms of fatigue-sadness predicted prognosis in univariate (hazard ratio [HR]=1.8, 95% CI 1.1-3.0, P=.025) and multivariate analysis (HR=1.8, 95% CI 1.1-2.9, P=.025). Symptoms of anhedonia (HR=1.6, 95% CI 0.9-2.8, P=.102) and depressive cognitions (HR=1.3, 95% CI 0.7-2.2, P=.402) did not.

Conclusion

Symptoms of fatigue-sadness, but not other symptoms, were associated with increased risk of major cardiac events. Depression should be considered as a multidimensional, rather than a unidimensional, entity when designing interventions.     

急性脑卒中后发热及相关因素的前瞻性临床分析

目的探讨急性脑卒中后发热及相关临床因素。方法采用前瞻性试验设计,在住院治疗期、发病3周和3个月对614例急性脑卒中患者进行发热及各相关因素调查,并行单因素分析和多因素后退法Logistic回归分析。结果单因素分析显示下列因素与发热之间具有统计学意义:(1)住院治疗期:感染、卒中分型、OCSP分型、脑出血后破入脑室、吞咽困难、侵人性操作、应用H_2受体阻滞剂、年龄、性别、出血体积、48h神经功能缺损评分、48h Glassgow评分;(2)预后:3周Glassgow评分、3周神经功能缺损评分、3周MMSE评分、3周死亡、3个月死亡、3个月ADL评分;(3)感染性发热与非感染性发热差异:卒中分型、吞咽困难、首次发热持续时间、Glassl-2。Logistic回归分析显示与发热相关的独立因素有4个:感染、应用H_2受体拮抗剂、48h Glassgow评分、3周神经功能缺损评分。结论急性脑卒中后发热影响患者的预后,感染与易感因素防治是急性脑卒中综合治疗的重点,感染性发热与非感染性发热的鉴别和深入研究具有重要临床意义。     

Psychological factors and subjective cognitive complaints after stroke: Beyond depression and anxiety

ABSTRACT

Subjective Cognitive Complaints (SCC) are common after stroke and adversely affect quality of life. In the present study, we determined the associations of depression, anxiety, perceived stress and fatigue with post-stroke SCC, and whether these associations were independent of objective cognitive functioning, stroke characteristics and individual differences in personality traits and coping styles. Using a cross-sectional design, SCC and psychological measures were obtained in 208 patients (mean 3.3?±?0.5 months after stroke; 65.9% men; mean age 64.9?±?12.4 years). SCC were assessed using the Checklist for Cognitive and Emotional consequences following stroke (CLCE) inventory. Validated questionnaires were used to measure depression and anxiety (Hospital Anxiety and Depression Scale), perceived stress (Perceived Stress Scale), fatigue (Fatigue Assessment Scale), personality traits (Eysenck Personality Questionnaire Revised Short Scale) and coping style (Utrecht Coping List). Multivariate hierarchical linear regression analyses were used to adjust for covariates. Depression (β?=?0.35), anxiety (β?=?0.38), perceived stress (β?=?0.39), and fatigue (β?=?0.39) were associated with CLCE scores, independent of demographic, cognitive performance and stroke-related covariates. After including personality traits and coping styles in the model, independent associations with CLCE scores were found for fatigue (β?=?0.26, p?=?.003) and neuroticism (β?=?0.21, p?=?.05). Interventions aimed at improving psychological resilience and increasing energy levels might be a worthwhile addition to stroke rehabilitation programmes by reducing SCC and improving quality of life.     

缺血性脑卒中患者远期抑郁症状的发生率及相关因素分析

目的探讨首发缺血性脑卒中(IS)偏侧肢体功能障碍患者远期抑郁症状(DS)的发生率及影响因素。方法前瞻性研究连续入选商丘市第一人民医院神经内科2012-11—2013-07收治的首发IS偏侧肢体功能障碍患者126例,入组后收集患者一般资料并采用美国国立卫生研究院卒中量表(NIHSS)、改良Rankin Scale(MRS)评分进行评估,发病后2~3a采用NIHSS、MRS评分、Barthel指数(BI)、脑卒中专用生活质量量表(SS-QOL)、汉密尔顿抑郁评分量表(HDRS)再次随访。通过单因素分析筛选出与远期抑郁症状(DS)具有显著性联系的因素后,使用非条件Logistic回归分析DS的影响因素。结果首发IS偏侧肢体功能障碍患者中远期抑郁症状发生率38.6%(44/114),其中轻、中、重度分别占19.3%(22/114)、11.4%(13/114)、7.9%(9/114)。多因素非条件Logistic回归分析结果显示,首发IS偏侧肢体功能障碍患者远期DS的影响因素包括文化程度(OR=2.847,95%CI=1.241~6.532)、BI(OR=0.763,95%CI=0.648~0.916)、SS-QOL评分(OR=0.970,95%CI=0.937~0.989)。且轻、中、重度抑郁症状患者的远期BI评分(F=29.426,P0.01)和SS-QOL评分(F=21.379,P0.01)的总体均数不同。结论 IS偏侧肢体功能障碍患者远期DS的危险因素为文化程度高,保护因素为远期BI评分高、生活质量高。其中远期BI评分、SS-QOL评分越低,IS偏侧肢体功能障碍患者的远期抑郁症状越重。日常生活能力的恢复及生活质量的提高等可能是改善IS偏侧肢体功能障碍患者远期抑郁症状的重要措施。     

Prospective study of factors influencing the persistence of symptoms in hospitalised patients with acute infection

Sequential patients, aged 18-50, admitted to an Infectious Diseases Unit of a large teaching hospital with an acute infection, completed validated psychometric questionnaires on admission and were followed up at three monthly intervals for 12 months. 34% of patients available for follow-up remained symptomatic at 3 months, but by 6 months and for the rest of the study, only about 20% of patients available for follow-up remained symptomatic. Symptoms resembled those of the initial infection at 3 months, but for the remainder of the study, most patients complained of nonspecific symptoms of tiredness and lassitude. Patients symptomatic at 3 and 6 months (S+) had significantly higher depression scores on admission compared with nonsymptomatic group (S-) (P<.05). Stepwise logistic regression revealed that case level depression on admission was predictive of a 13-fold increase in the chance of remaining symptomatic at 6 months. These associations were lost by 12 months. In conclusion, this study has supported the hypothesis that psychopathology occurring at the time of an acute infection can lead to persistent symptoms that at least in the short term resemble those of the acute illness. This relationship breaks down after 6 months, when symptoms become less specific and may be conditioned by exhausting and distressing social situations other than acute illness.     

急性脑卒中患者的精神障碍及其相关因素分析

目的探讨急性脑卒中患者的心理健康状况及其相关因素，为临床更有效的治疗脑卒中提供依据。方法采用焦虑自评量表（SAS）、抑郁自评量表（SDS）和SCL-90症状自评量表（SCL-90）对急性脑卒中患者和正常对照者各168例进行测评，并且在脑卒中的不同病变性质之间、病灶部位之间以及病灶大小之间进行神经心理学的对照研究。结果脑卒中组SAS焦虑状态总分、SDS总分以及精神情感症状、躯体化障碍、精神运动性障碍、抑郁的心理障碍的评分也均明显高于对照组（P〈0．01），SCL-90总分以及躯体化、抑郁、焦虑、紧张、强迫、睡眠障碍的评分也均明显高于对照组（P〈0．01）；在脑卒中组内左半球病变、皮层病变、多发病灶、大病灶和大脑前部受损者的神经心理学改变程度比右半球病变、皮层下病变、单发病灶、小病灶和大脑后部受损者重（P〈0.05）。结论急性脑卒中患者同时存在不同程度的焦虑抑郁症状，且有较多的心身症状；急性脑卒中患者有神经心理学改变，且神经心理学改变与病变性质、部位、数量和面积有关。     

Risk factors for fatigue in patients with epilepsy

Fatigue is highly prevalent in patients with epilepsy and has a major impact on quality of life, but little data is available on its effects and management in epilepsy. To identify the incidence and risk factors of fatigue in patients with epilepsy, 105 epilepsy patients (45 women and 60 men) were enrolled in our study. Demographic and clinical data were collected and psychological variables including fatigue, sleep quality, excess daytime sleepiness, anxiety, and depression were measured by Fatigue Severity Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale, respectively. Of 105 patients, 29.5% exhibited fatigue (FSS score ⩾4). We found no correlation between the occurrence of fatigue and any of our demographic or clinical variables. Fatigue is correlated with low sleep quality, anxiety, and depression, but not with excess daytime sleepiness. Thus, we concluded that fatigue is highly prevalent in patients with epilepsy, and that low sleep quality, anxiety, and depression are significantly correlated with fatigue in epileptics, while excess daytime sleepiness not.     

缺血性卒中恢复期伴失眠的危险因素研究

目的探讨缺血性脑卒中患者恢复期伴失眠的临床及神经心理学危险因素。方法纳入225例急性缺血性脑卒中患者,在卒中后3个月进行失眠及神经心理学评估。失眠的评估采用标准的失眠问卷,抑郁症状评估采用汉密尔顿抑郁量表(HDS),焦虑症状评估采用汉密尔顿焦虑量表(HAS)。比较失眠及非失眠2组间的临床及神经心理学指标,应用Logistic回归分析失眠的影响因素。结果 67例(29.8%)存在失眠。失眠患者入院NIHSS评分及HDS评分较非失眠者更高(P0.05),卒中前失眠更常见(52.2%vs.12.7%,P0.001)。Logistic回归分析显示,卒中前失眠症状(OR=2.729,95%CI=1.550~4.804,P=0.001)及HDS(OR=1.240,95%CI=1.158~1.327,P0.001)均为缺血性卒中患者伴失眠的独立危险因素。结论缺血性卒中恢复期伴失眠十分常见。卒中前存在失眠症状以及卒中后抑郁症状的严重程度是伴失眠的主要影响因素。     

Regional disparities in acute and post-acute care of stroke patients in France, 2015

Objective

The aim of this study was to assess regional variations of the hospital management of stroke patients during acute and post-acute phases in France in 2015.

Early depressive symptoms after stroke: neuropsychological correlates and lesion characteristics

OBJECTIVE: To examine the relation between depressive symptoms and specific cognitive functions in patients with a recent stroke and to examine associations with lesion characteristics. METHODS: We studied 126 of 183 consecutive patients within 3 weeks after a first-ever symptomatic stroke (mean interval, 8.3+/-4.3 days). Presence and severity of depressive symptoms was assessed with the Montgomery Asberg Depression Rating Scale. Neuropsychological functioning was examined by means of a detailed neuropsychological examination covering six cognitive domains. We included a healthy control group (N=75) to obtain normative data for the neuropsychological examination. Functional impairment was measured with the modified Barthel Index and the modified Rankin Scale. Symptomatic and preexistent lesion characteristics were determined on CT or MRI. RESULTS: Of the included patients, 40% demonstrated mild and 12% moderate to severe depressive symptoms. Severity of depressive symptoms was related to lesion volume (p=0.008), functional impairment (all p<0.004), and degree of overall cognitive impairment (p=0.005). After adjustment for lesion size, a specific neuropsychological profile emerged in patients with moderate to severe depressive symptoms, affecting primarily memory, visual perception, and language (all p<0.05). No association was found between severity of depressive symptoms and lesion location, presence of preexistent lesions (white matter lesions and silent infarcts), and demographic factors (age, education, and gender). CONCLUSIONS: Moderate or severe symptoms of depression in the early stage poststroke are associated with a specific pattern of cognitive impairment, lesion size, and functional status. We suggest that depressive symptoms early after stroke are, at least in part, a reactive phenomenon secondary to severe cognitive and functional deficits.     

乳腺癌术后抑郁发生率及相关危险因素研究

目的 调查乳腺癌术后患者抑郁的发生状况及相关危险因素.方法 应用Beck抑郁量表(BDI)对243例连续入组的乳腺癌术后患者进行抑郁评估,并记录患者的一般资料和乳腺癌的临床资料.结果 以BDI总分4/5为界,92例(37.9%)乳腺癌术后患者存在有明显的抑郁症状,抑郁组的年龄、月收入显著低于非抑郁组(t=-2.306,P=0.022;χ2=7.767,P=0.021),而手术方式、术后时间、临床肿瘤分期、是否伴随其他躯体疾病、何种治疗方式、ER受体情况在抑郁组和非抑郁组间未发现显著性的差异.结论 乳腺癌术后抑郁的发生比例较高,低龄、低收入可能是乳腺癌术后抑郁发生的危险因素.     

Flexors activity of affected upper extremity in stroke patients during different standing conditions and their relationships with clinical scales: a cross-sectional study

ABSTRACT

Purpose: To explore the flexors activity of affected upper extremity in stroke patients during different standing conditions and their relationships with clinical scales.

Materials and methods: Sixteen stroke patientswere recruited, all subjects stood on balance equipment with four different standing postures. The electromyogram (EMG) simultaneously recorded the muscle activity of bilateral biceps brachii, triceps brachii, flexor carpi radialis and extensor carpi radialis and their integrated electromyogram were figured out the contraction rate of elbow flexors(biceps brachii/triceps brachii) and wrist flexors(flexor carpi radialis/extensor carpi radialis). All subjects were assessed using Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Berg Balance Scale (BBS), Barthel Index (BI) and Modified Ashworth Scale (MAS).

Results: The contraction rate of affected elbow flexors in the condition of feet together on soft surface was significantly higher than that in the condition of feet separatedon hard surface (P < 0.05). The contraction rate of affected elbow flexors in four standing conditions tended to increase, all the values of which were greater than numerical value1. The difference in the contraction rate of elbow flexor between the affected side and the unaffected side was statistically significant (P < 0.05). No correlation was observed between the contraction rate of the elbow flexor and the results of MAS, FMA-UE, BBS and BI regardless of the standing conditions.

Conclusions: The contraction rates of elbowflexor in the affected side increase with the difficulty in different standing postures,and it may be a good index to reflect the changes of muscle tone in postural control.     

Psychological health of caregivers and association with functional status of stroke patients

Objective: Stroke does not only affect the physical state of patients but also the emotional state of their relatives, most effectively their caregivers. The study aims to examine the mood of caregivers experienced with care for patients with stroke who are highly dependent on the assistance and also to establish the relationship between the emotional state of caregivers and the severity of disability of the patients.

Methods: This study contained a total of 76 patients with sufficient cognitive functions and severe physical disabilities with hemiplegia caused by a cerebrovascular accident and their caregivers and 94 controls. The functional state of patients was assessed by the Barthel Index (BI). Furthermore, emotional state of the caregivers was assessed by the Hospital Anxiety and Depression Scale (HADS) and their life quality was assessed by the SF36 Health Survey.

Results: The mean anxiety (9.73 ± 4.88) and depression rates (9.81 ± 5.05) in the caregivers were significantly higher than those in controls (p<0.001, respectively). Significant impairments were observed in both their mental and physical health. Regression analysis also showed a significant negative correlation between the BI scores and the HADS scores.

Conclusion: Caregivers had an impaired emotional state and the level of their anxiety was associated with the severity of functional disability of the patients. Therefore, the support provided to the caregiver might be influential on the functional recovery of the patients.