脑卒中患者抑郁状态对生活质量和神经功能恢复的影响

背景脑卒中后抑郁状态(post-stroke depression,PSD)及其抗抑郁治疗对脑卒中患者神经功能恢复和生活质量的影响尚无肯定的结论.PSD的发生率较高,因此,此项研究应向定量化深入.目的通过对PSD和抗抑郁干预,探讨PSD对脑卒中患者生活质量和神经功能恢复的影响.设计以诊断为依据,随机对照研究.单位河南安阳钢铁集团公司职工总医院神经内科,湖北中医学院神经科,湖北省红安县人民医院内科.对象2001-08/2002-03河南安阳钢铁集团公司职工总医院神经科门诊和住院的PSD患者41例,男25例,女16例;年龄(61.7±12.1)岁,随机分为抑郁组20例和非抑郁组21例.干预抗抑郁组在第1个月汉密顿抑郁量表(HAMD)评定后开始服用阿米替林和心理辅导.在发病1个月和3个月时采用卒中生活质量量表(SS-QOL)和欧洲临床神经功能缺失评分标准(ESS)进行评定,观察神经功能缺失、生活质量和抑郁症状的改善.主要观察指标①两组患者在第1,3个月时HAMD,ESS和SS-QOL评分.②SS-QOL各项指标评分结果.③抗抑郁组治疗效果.结果抗抑郁组治愈者16例,治愈率76%(16/21),4例比治疗前减少5分以上,总有效率为95%(20/21).抗抑郁组SS-QOL评分显示在情绪、体能、家庭活动、社会活动、思维能力和工作能力等方面均有不同程度的改善.结论PSD影响脑卒中患者神经功能康复和生活质量,抗抑郁治疗对改善患者预后具有一定意义.

Effects of post-stroke depression on the quality of life and the recovery of neurological function

BACKGROUND: There was no positive conclusion on the effects of the post-stroke depression(PSD) and its treatment of anti-depression on the recovery of neurological function and the quality of life (QOL) of the stroke patients. The incidence of PSD was high, so the research on the effects should be deepened quantitively.OBJECTIVE: To investigate the effects of PSD on QOL and the recovery of neurological function of stroke patients via the interventions of PSD and anti-depression.DESIGN: A randomized and controlled study based on the diagnosis.SETTING: Department of Neurology, General Staff Hospital of Anyang Steel and Iron Group Co. of Henan Province; Department of Neurology, Hubei College of Traditional Chinese Medicine; Department of Internal Medicine,Hongan County People' s Hospital of Hubei Province.PARTICIPANTS: A total of 41 PSD outpatients and inpatients, 25 male and 16 female with the age of(61.7 ± 12. 1) years old, were selected from the Department of Neurology, General Staff Hospital of Anyang Steel and Iron Group Company of Henan Province from August 2001 to March 2002. All the patients were randomly divided into depression group with 20 patients and non-depression group with 21 patients.INTERVENTION: Before receiving amitriptyline and the mental guidance,the patients in anti-depression group were assessed with Hamilton depression rating scale(HAMD) during the first month. Stroke scale quality of life(SS-QOL) and European clinical neurologic impairment scale(ESS) were adopted to assess and observe the improvement of neurologic impairment,QOL and depression symptom during the first and the third month episode.RESULTS: Among the patients in anti-depression group, 16 patients were cured with the cure rate of 76% (16/21). Four patients had at least five score decreased after treatment, and the total effective rate was 95% (20/21 ) . The scores of SS-QOL in anti-depression group showed that there were some improvements on many aspects, such as mood, physical ability, family activities, social activities, thinking ability, work ability and so on.CONCLUSION: PSD can affect the recovery of neurological function and QOL of stroke patients. And the treatment in anti-depression group is significant to the improvement of the prognosis of patients.