脑梗死患者心理状态及其相关因素分析

背景:脑梗死不仅可直接导致患者产生抑郁症状,还可以间接影响患者心理状态,从而对脑梗死患者的治疗过程产生不同程度的负面影响。目的:分析脑梗死患者住院期间的心理状态及其相关因素。设计:横断面观察。单位:梅州人民医院神经内科。对象:选取梅州人民医院2000～2002年住院的脑梗死患者91例,经CT明确诊断,神志清楚、病情相对稳定,能独立完成问卷填写。方法:①采用焦虑自评量表和抑郁自评量表对91例脑梗死患者进行独立问卷调查,测试前由统一医务人员进行讲解指导。焦虑自评量表与抑郁自评量表均包含7个问题,两表累积评分均为0～21分,>9分者为焦虑或抑郁。②从躯体因素、社会因素两方面来评定脑梗死患者产生抑郁及焦虑的情况。躯体因素包括头晕、头痛、失眠、肢体活动障碍(指肌力在4级以下,无法自主行走者)、不良反应(指肺部感染、泌尿系感染、压疮和消化道出血、发热等);社会因素包括年龄、性别、婚姻、教育、家人关心程度、经济状况(状况好指能支付所有住院费用,状况差指不能支付)以及住院时间延长(>1个月)。调查结果采用Binary分析,相对危险度估计值表达为Exp穴B雪,B为偏回归系数。主要观察指标:抑郁、焦虑与脑梗死患者躯体因素及社会因素的相关性。结果:实验选取脑梗死患者91例,全部进入结果分析。①抑郁与脑梗死患者躯体因素及社会因素的相关性:91例患者中,抑郁患者38例(41.8%),抑郁与脑梗死患者的躯体因素及社会因素均密切相关。躯体因素方面,存在头痛、头晕、肢体活动障碍及不良反应者的抑郁发生率明显高于无这些症状者(P<0.01);社会因素方面,住院期间家人不够关心、住院时间延长的抑郁发生率明显增高(P<0.01)。抑郁发生与患者的年龄、性别、婚否、受教育程度、经济状况及睡眠状况无关(P>0.05)。②焦虑与脑梗死患者躯体因素及社会因素的相关性:焦虑患者28例(30.8%),焦虑与住院期间患者的躯体因素及社会因素均密切相关。在躯体因素方面,存在不良反应、瘫痪肢体功能恢复慢者的焦虑发生率明显高于无不良反应、肢体功能恢复良好者(P<0.05);社会因素方面,女性、受教育程度高、家人关心不够、经济状况差者的焦虑发生率较高(P<0.05)。焦虑发生与患者的年龄、婚否、住院时间、头痛、头晕以及失眠症状无关(P>0.05)。结论:焦虑与抑郁是脑梗死患者住院期间常见的心理障碍,与躯体因素及社会因素均密切相关,提示对脑梗死住院患者应加强心理治疗及护理。

Psychological mood and its related factors in patients with cerebral infarction

BACKGROUND: Cerebral infarction can not only directly cause depression, but also indirectly influence psychological mood so as to cause negative effect during therapeutic process at various degrees.OBJECTIVE: To study the psychological mood and related factors of the inpatients with cerebral infarction.DESIGN: Cross-section observation.SETTING: Neurological Department of Meizhou People's Hospital of Guangdong Province.PARTICIPANTS: A total of 91 inpatients with cerebral infarction were selected from Meizhou People's Hospital of Guangdong Province from 2000 to 2002. All patients were diagnosed as cerebral infarction with clear mind and stable illness with CT. They were inquired to answer questionnaires individually.METHODS: ① Ninety-one patients with cerebral infarction were inquired questionnaires individually with Self-Rating Anxiety Scale (SAS) and Selfrating Depression Scale (SDS). Both scales contained 7 questions and the total scores were 0-21 points. If scores were more than 9 points, patients were diagnosed as anxiety or depression. ② Induction of depression and anxiety was evaluated on the aspects of physical and social factors. Physical factors included dizziness, headache, agrypnia, active disorder of limbs (muscle force was lower than grade 4 and patients could not walk individually) and poor response (pulmonary infection, urologic infection, bedsore,hemorrhage of alimentary tract, febrile, etc.). Social factors included age,sex, marriage, education, careful degree, economic status (whether patients were able to afford all cost of hospitalization or not) and overtime of hospitalization (＞ 1 month). Results were assessed with Binary analysis. The relative risk of value was expressed as Exp (B), and B means partial regression coefficient.MAIN OUTCOME MEASURES: Correlation among depression, anxiety,physical factor and social factor of patients with cerebral infarction.RESULTS: All 91 patients were involved in the final analysis. ① Correlation of depression with physical and social factors. Of the 91, 38 patients (41.8%) suffered from depression. Therefore, depression was closely correlated with physical and social factor. Physical factors of induction of depression, such as headache, dizziness, active disorder of limbs and poor response, wereas higher than those patients who did not have (P ＜ 0.01).Social factors of incidence of depression of patients who had poor care and overtime of hospitalization were increased (P ＜ 0.01). Onset of depression was not related to age, sex, marriage, educational level, economic status and sleeping status (P ＞ 0.05). ② Correlation of anxiety with physical factor and social factor: Of the 91 patients, 28 cases (30.8%) had anxiety;therefore, anxiety was closely correlated with physical and social factors.Physical factors of induction of anxiety, such as poor response and slow recovery of paralysis, were higher than those patients who did not have (P＜ 0.05). Social factors of induction of anxiety in female patients who had high educational level, poor care and poor economic status were increased (P ＜ 0.05). Onset of anxiety was not related to age, marriage, time of hospitalization, headache, dizziness and asomnia (P ＞ 0.05).CONCLUSION: Anxiety and depression are the most common psychological disturbances in patients with cerebral infarction, which are closely correlated with physical and social factors. Thus psychotherapy and care should be performed in inpatients with cerebral infarction.