康复训练联合心理干预治疗脑卒中后抑郁的对照研究(1)
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【摘要】 目的 探讨康复训练联合心理干预治疗脑卒中后抑郁的临床疗效。方法 78例脑卒中后抑郁患者随机分为研究组和对照组各39例，对照组给予常规脑卒中药物治疗与康复训练，研究组在此基础上进行心理干预，观察8周。于治疗前与治疗第4周末、第8周末采用汉密尔顿抑郁量表(HAMD)、改良的Barthel指数(MBI)评定疗效。结果 两组患者治疗前HAMD、MBI评分比较差异无统计学意义(P>0.05)，治疗第4周末、第8周末，研究组的HAMD评分低于对照组，治疗第8周末的MBI评分高于对照组，差异有统计学意义(P<0.05)。结论 康复训练联合心理干预能有效改善脑卒中后抑郁患者的抑郁症状，促进日常生活能力的恢复。
【关键词】 卒中后抑郁；康复；心理治疗
Contrast study of rehabilitation training combined with psychotherapyon post-stroke depression.
ZHEN Jun, ZHENG Rong, ZHOU Shao-hui, et al. Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000,China
【Abstract】 Objective To observe the efficacy of rehabilitation training combined with psychotherapy on post-stroke depression. Methods 78 patients with post-stroke depression were randomly divided into research and control group (each n=39), both groups were treated withroutine medicine and rehabilitation, while research group was treated with psychotherapy for 8 weeks. Effects were assessed by the Hamilton Depression Scale(HAMD) and the modified Barthel Index (MBI) before treatment and at the end of the 4th,and 8th week treatment in two groups. Results There were no significant different in HAMD and MBI between two groups before treatment(P>0.05).At the end of the 4th,and 8th week treatment in research group the assessment of HAMD was reduced remarkably than control group, and at the end of the 8th week treatment MBI improved more than control group, the differences were significant(P<0.05).Conclusion Rehabilitation training combined with psychotherapy can effectively improve symptoms of post-stroke depression, promote the recovery of activities of daily living in patients with post-stroke depression.
【Key words】 Post-stroke depression;Rehabilitation;Psychotherapy
脑卒中后抑郁(post-stroke depression, PSD)是卒中后最常见的心理障碍，国内发病率约为34.2%~76.1%[1]，严重影响患者的康复训练，延迟患者功能恢复，降低日常生活质量，并增加脑血管病患者的死亡率。抗抑郁药物虽能有效改善症状，但多数有明显的不良反应。本研究对PSD患者采用康复训练联合心理干预进行治疗，取得了良好效果，结果报道如下：
1 资料与方法
1.1 一般资料 78例均为本院神经内科、康复科住院及门诊就诊的PSD患者。纳入标准：①符合1995年中华医学会第四届全国脑血管病学术会议修订的脑卒中诊断标准[2]，并经头颅CT或MRI证实。②符合中国精神疾病分类与诊断标准(CCMD-3)中有关抑郁的诊断标准[3]。③汉密尔顿抑郁量表(HAMD)[4]17项评分≥18分。④年龄≤70岁。⑤意识清楚，能配合治疗，无明显失语与认知障碍，既往无器质性脑病及精神障碍病史，未接受过抗抑郁药物治疗 ......
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