康复治疗对脑卒中后患者抑郁状态及日常活动能力的影响

背景脑卒中后抑郁是脑卒中后最常见的情绪变化,其发病率较高,并且严重影响患者近、远期的功能预后,影响其恢复期的生活质量.目的通过对脑卒中后抑郁患者的干预治疗,探讨综合康复治疗对脑卒中后抑郁患者日常生活活动能力和抑郁心理的影响.设计以患者为研究对象,以诊断为依据,随机对照研究.单位一所大学医院的干部病房.对象2001-10/2002-03天津医科大学总医院干部病房住院患者60例,男34例,女26例,随机分为康复组和对照组各30例.干预康复组采取常规药物治疗+综合康复治疗(运动疗法+心理治疗),对照组仅采用常规药物(降压,改善脑循环及对症)治疗.在患者入选时、病程3,6个月时分别进行Barthel指数和汉密顿抑郁量表评定.主要观察指标康复组和对照组在第3,6个月时Barthel指数和汉密顿抑郁量表评分.结果康复组患者Barthel指数得分在疗程3个月(68.0±2.9)和6个月(70.0±3.5)时显著高于对照组(62.0±3.3,65.0±3.8),差异有非常显著性意义(P＜0.001,0.01),汉密顿抑郁量表得分在疗程3个月(8.9±4.9)和6个月(8.7±5.1)时则明显低于对照组(15.2±5.6,14.9±8.1),差异有显著性意义(P＜0.05).结论综合康复治疗能够有效改善脑卒中后抑郁患者的日常生活活动能力,减轻抑郁心理.

Impacts of rehabilitative therapy on post-stroke depression and the ability of daily life

BACKGROUND: Post-stroke depression(PSD) is the most common emotional change after stroke. It has high morbidity, which also seriously affects the near and long term functional prognosis of the patients and affects the quality of life (QOL) of the patients during convalescence.OBJECTIVE: To investigate the impacts of integrated rehabilitative therapy on post-stroke depression and ability of daily life(ADL) through interventional therapy in patients with post-stroke depression.DESIGN: A randomized controlled study with the patients as subjects basedon diagnosis.SETTING: Department of cadre in a university hospital.PARTICIPANTS: Sixty cases including 34 males and 26 females hospitalized in the Department of Cadre of the General Hospital Affiliated to Tianjing Medical University between October 2001 and March 2002 were randomly divided into rehabilitation group( n = 30) and control group( n = 30).INTERVENTIONS: Patients of rehabilitation group received both routine medication and integrated rehabilitative therapy (cinesiotherapy + psychotherapy) while the patients of control group only received routine medication(decompression, improving cerebral circulation and symptomatic therapy) . Barthel index(BI) and Hamilton rating scale for depression(HAMD)were used to assess the patients at admission, the 3rd month and the 6th month during the course of the disease.MAIN OUTCOME MEASURES: BI and HAMD score at the 3rd and 6thmonth in patients of rehabilitation group and control group.RESULTS: BI at 3rd month or 6th month was (68.0 ± 2.9) or (70.0 ± 3.5)in patients of rehabilitation group, which was significantly higher than (62.0±3.3) at 3rd month and (65.0±3.8) at 6th month in patients of control group( P ＜ 0. 001, 0. 01) . HAMD score at 3rd month or 6th month was(8.9 ±4.9) or(8.7 ±5.1) in patients of rehabilitation group, which was significantly lower than(15.2 ±5.6) at 3rd month or(14. 9 ±8. 1) at 6th month in patients of control group ( P ＜ 0.05).CONCLUSION: Integrated rehabilitative therapy can effectively improve the ADL of patients with post-stroke depression and relieve depression.