文章摘要
林雪,刘汝茜.卒中单元综合治疗对脑卒中后抑郁干预效果及对吞咽和认知功能的影响[J].中国临床保健杂志,2020,23(4):542-546.
卒中单元综合治疗对脑卒中后抑郁干预效果及对吞咽和认知功能的影响
Effect of comprehensive intervention of stroke unit on post-stroke depression and its effect on dysphagia and cognitive function
投稿时间:2019-06-10  
DOI:10.3969/J.issn.1672-6790.2020.04.026
中文关键词: 卒中  神经康复  抑郁  吞咽障碍  认知功能障碍
英文关键词: Stroke  Neurological rehabilitation  Depression  Deglutition disorders  Cognitive dysfunction
基金项目:河北医学科学研究重点课题计划(20181588)
作者单位E-mail
林雪 哈励逊国际和平医院神经内科,衡水 053000 h13lni@163.com 
刘汝茜 哈励逊国际和平医院神经内科,衡水 053000  
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中文摘要:
      目的 探讨卒中单元综合治疗对脑卒中后抑郁(PSD)及对吞咽和认知功能等相关治疗的有效性。方法 选取157例PSD患者按随机数字表法分为对照组(普通病房治疗)和观察组(卒中单元治疗)。对照组给予神经内科常规治疗,在对照组基础上观察组给予个体化的心理治疗、认知行为干预、吞咽功能等神经康复等卒中单元综合治疗。患者于治疗前及治疗1周、2周、4周、8周、12周时进行汉密尔顿抑郁量表(HAMD)评分、改良Barthel指数(MBI) 评分、简易智能状态检查(MMSE)、简式Fugl-Meyer运动功能(FMA)评分等评估疗效。结果 共纳入157例PSD患者,82例对照组和75例观察组患者在治疗前及治疗1周时在HAMD、MMSE、FMA和MBI评分组间差异无统计学意义(P均>0.05),观察组在治疗2周、4周、8周及12周时HAMD显著低于同期对照组,MBI和MMSE评分显著高于同期对照组,而FMA评分方面观察组在治疗4周、8周及12周时显著高于同期对照组(P均<0.05)。观察组在治疗4周及以后各时间点HAMD评分均较治疗前显著降低,而MBI和MMSE评分在治疗2周及以后各时间点即较治疗前显著升高,而FMA运动功能评分方面观察组在治疗4周及以后各时间点均显著高于治疗前(P均<0.05)。此外,观察组吞咽功能障碍治疗的总有效率在治疗2周(77.8%)和4周时(85.2%)均显著高于同期对照组(51.6%和77.4%)(P均<0.05)。结论 卒中单元综合治疗不仅可使PSD患者的抑郁症状在早期得到改善,还能改善其吞咽障碍及认知能力,从而使PSD患者在躯体和心理上共同恢复并提高其生活质量。
英文摘要:
      Objective To investigate the efficacy of comprehensive intervention of stroke unit in the treatment of post-stroke depression,dysphagia and cognitive function.Methods According to random number table method,157 patients with PSD were randomly divided into control group and observation group.Based on the general treatment of the control group,the observation group was given individualized psychotherapy,cognitive behavioral intervention,neurological function rehabilitation,swallowing function professional rehabilitation training and other comprehensive treatment of stroke unit.Hamilton Depression scale (HAMD),modified Barthel index (MBI) score,Minimum Mental State Examination (MMSE) and simple Fugl-Meyer motor function (FMA) score and other assessments were used to evaluate the curative effect before treatment and 1 week,2 weeks,4 weeks,8 weeks and 12 weeks after hospitalization.Results A total of 157 patients with PSD were enrolled,of whom 75 patients were included in the observation group and 82 patients in the control group.There was no significant difference in HAMD score,MBI score,FMA score and MMSE score between the control group and the observation group before treatment and 1 week after treatment (P > 0.05).At the 2nd,4th,8th and 12th week of treatment,the HAMD scores in the observation group were significantly lower than those in the control group,meanwhile,the scores of MBI and MMSE in the observation group were significantly higher than those in the control group.However,the FMA scores in the observation group were significantly higher than those in the control group at 4th,8th and 12th week of treatment.The HAMD scores in the observation group at the 2nd,4th,8th,12th week of treatment were significantly lower than those before treatment,and the MBI and MMSE scores in the observation group at the 2nd,4th,8th,12th week of treatment were significantly higher than those before treatment.However,the FMA scores in the observation group at the 4th,8th,12th week of treatment were significantly higher than those before treatment (all P < 0 05),meanwhile,the HAMD scores in control group at 4th,8th,12th week of treatment were significantly lower than those before treatment.In addition,the total effective rates of dysphagia in the observation group at 2th week (77.8%) and 4th week (85.2%) of treatment were higher than those in the control group (51.6% and 77.4%).Conclusions Comprehensive interventional therapy of stroke unit can not only improve the depressive symptoms of PSD patients in the early stage,but also improve their dysphagia and cognitive function in the early stage.
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