首发脑卒中后抑郁患病率及影响因素

摘要

目的：纵向分析首发脑卒中后抑郁（ PSD）的患病情况及影响因素。方法收集急性脑卒中患者139例，在2 w、6个月、12个月、18个月进行随访。调查采用抑郁自评量表（SDS）、日常生活能力评定量表（BI）、神经功能缺损量表（NIHSS）、社会支持调查量表（MOS-SSS）。分析不同时期患者抑郁发病率，并对影响因素进行单因素和Logistic回归分析。结果脑卒中后2 w（Ⅰ组）、6个月（Ⅱ组）、12个月（Ⅲ组）、18个月（Ⅳ组）抑郁发病率分别为7.91％（11／139）、19.42％（27／139）、27.34％（38／139）、35.97％（50／139），差异有统计学意义（χ2＝33.865，P＝0.000）；结果4个时段轻、中、重度抑郁之间的发病率相比较，均有统计学差异（均P＜0.05）。4组间的 BI、 NIHSS、MOS-SSS 评分、既往病史、本次发病病程、患者的人均月收入、患者在院期间护理费用，均具有显著差异（均P＜0.05）。Ⅱ组、Ⅲ组、Ⅳ组NIHSS、MOS-SSS评分、人均月收入均显著低于Ⅰ组（P＜0.05）；Ⅱ组、Ⅲ组、Ⅳ组BI评分、既往病史比例、疾病病程、护理费用均显著高于Ⅰ组（P＜0.05）。多因素Logistic回归分析发现，NIHSS 评分高、患者的既往病史、本次发病病程亦是患者抑郁的独立危险因素（P＜0.05），而BI评分高、人均月收入高和护理费用高是抑郁的保护因素（P＜0.05）。结论 BI、NIH-SS评分、患者既往病史、本次发病病程、患者的人均月收入、护理费用是脑卒中致残后抑郁的影响因素，可为制定有效护理措施提供依据。%Objective To investigate the prevalence of depression and its influencing factors in patients with first episode of stroke . Methods A questionnaire was performed in 139 acute stroke patients.Depression self rating scale (SDS), ADL Rating Scale(BI),Nation-al Institutes of Health Stroke Scale (NIHSS),Social Support Scale(MOS-SSS)were used to survey.Results The depression incidences at 2 w,6,12, 18 months were 7.91%(11/139), 19.42%(27/139), 27.34%(38/139), 35.97%(50/139)(χ2=33.865,P=0.000).There were differences in the incidences of mild ,moderate,severe depression among the four periods (P<0.05 ),and in BI,NIHSS,MOS-SSS,past medical history,duration, family per capita income ,care spending among the four periods (P<0.05).The NIHSS,MOS-SSS score,family per capita income were lower in groups Ⅱ,Ⅲ,Ⅳthan those in group Ⅰ( P<0.05 ) ,the scores of BI ,proportion of past medical history ,duration were higher in groups Ⅱ,Ⅲ,Ⅳthan those in group Ⅰ(P<0.05).The scores of NIHSS,past medical history,duration were independent risk factors of depression ( P<0.05 ) ,the scores of BI and family per capita income ,care spending were a protective factor of depression ( P<0.05).Conclusions Scores of BI and NIHSS,past medical history,duration,family per capita income ,care spending are independent fac-tors influencing depression of stoke , which provide a basis for putting forward effective nursing measures .