急性卒中后非语言障碍患者焦虑障碍的发生率及相关因素研究—130例单中心横断面调查数据分析

目的 调查急性卒中发病14d内的住院患者焦虑障碍的发生率及相关影响因素。方法 收集2009年5月至2009年10月期间北京天坛医院神经内科发病14 d以内的急性卒中住院患者130例，用汉密尔顿焦虑量表（the Hamilton Anxiety Scale，HAMA）进行焦虑障碍及程度的评价，并对伴有焦虑障碍患者的性别、年龄、文化程度、卒中类型、病灶侧别及发病后首次美国国立卫生研究院卒中量表（the National Institutes of Health Stroke Scale，NIHSS）评分等相关因素进行统计分析。结果 130例卒中患者在发病14±2 d全部完成HAMA量表评价，39例（30%）有卒中后焦虑障碍。其中40例（30.8%）可能有焦虑，32例（24.6%）肯定有焦虑，7例（5%）肯定有明显焦虑。精神性焦虑的评分为5.00（1.75～9.00）分；躯体性焦虑的评分为3.00（1.00～6.00）分。中老年组患者焦虑障碍的发生率明显高于青年组患者（P <0.05）。精神性焦虑症状和躯体性焦虑症状均较年轻者严重（P <0.05）。大学文化程度的患者焦虑障碍的发生率较低文化水平患者有更高的趋势（大学50%，高中28.6%，初中27.1%，小学25%，文盲33.3%）。在伴有焦虑障碍的患者中，有明显焦虑障碍的比例以中年以上患者更高，女性有更易患的趋势。焦虑的发生率与NIHSS评分呈正相关（r =0.197，P <0.05）。患者焦虑障碍的发生率与卒中类型及病灶侧别无明显相关性（P >0.05）。仅有不足1/3的伴有焦虑障碍的患者给予药物干预，以选择性5-羟色胺再摄取抑制剂（Selective serotonin reuptake inhibitors，SSRIs）类药物为主。结论 卒中后14 d内约有1/3的患者并发焦虑障碍，年龄和神经系统功能障碍是其主要的危险因素，年龄也可影响焦虑障碍的程度。此外，文化程度可在一定程度上影响卒中后患者焦虑障碍的发生。脑梗死患者有易出现焦虑障碍的趋势。目前综合医院对伴有焦虑障碍的患者药物干预明显不足。

Incidence and Related Factors of Anxiety Disorders In Non-aphasia patients After Acute Stroke-Cross-sectional Survey for 130 Patients

Objective To survey the incidence of anxiety disorder within 14 days after stroke and to analysis its related factors.
Methods One hundred and thirty inpatients which were selected from May 2009 to September 2009 in the department of Neurology in Beijing Tiantan Hospital, were evaluated with the Hamilton Anxiety Scale （HAMA） and analyzed the factors such as age, gender, literacy and the type, sides or the National Institutes of Health Stroke Scale （NIHSS） of stroke. Results All the 130 patients completed HAMA scale assessments within 14＋2 days, the incidence of anxiety disorder was 30% （N=39）. Forty patients had possible anxiety disorders, 32 patients had probable anxiety disorders, and 7 patients had apparent anxiety disorders probably. The score of spiritual anxiety was 5.00 （1.75-9.00）, and physical anxiety was 3.00 （1.00-6.00）. The patients who beyond 45 years old had higher incidence of anxiety disorder （P〈0.05）, the olders had more serious spiritual and physical anxiety than the youngers. The patients graduated from the university had higher incidence of anxiety than the others （university 50%vs senior school 28.6%vs junior sdhool 27.1%vs primary sdhool 25%vs iliteracy33.3%）. In the anxiety patients, the probable anxiety disorders patients were more common in the olders, but the female was more obvious. The correlation between NIHSS score and the incidence of anxiety was positive （R^2=0.034）. There were no significant differences between the cadence and the type or sides of stroke. Less than 1/3 patients with anxiety disorders were given drug intervention which mainly used selective serotonin reuptake inhibitors （SSRIs）.
Conclusion About 1/3 patients had anxiety disorders in the acute phase post stroke. The age and neurological impairments were the risk factors of anxiety disorders, and the age could influence the extent of anxiety disorders. The education might influence the incidence of anxiety disorders in some extent. At present, the intervention or treatment to the anxiety disorders was not enough in comprehensive hospitals.