作者：刘汝茜1 ，王婷婷 1 ，韩敬哲 1 ，张敬 2 ，郗红艳 1 ，闫海燕 1

单位：

1.053000 河北省衡水市，哈励逊国际和平医院神经内科；2.053000 河北省衡水市，哈励逊国际和平医院生殖医学科；通信作者：韩敬哲，E-mail：420612049@qq.com

Units：

1.Department of Neurology，Harrison International Peace Hospital，Hengshui 053000，China；2.Department of Reproductive Medicine，Harrison International Peace Hospital，Hengshui 053000，China；Corresponding author：HAN Jingzhe，E-mail：420612049@qq.com

关键词：

脑出血；卒中后抑郁；血肿特点；影响因素分析

Keywords：

Cerebral hemorrhage；Post-stroke depression；Hematoma characteristics；Root cause analysis

CLC：

R 722.151　R 749.42

DOI：

DOI：10.3969/j.issn.1008-5971.2020.01.y12

Funds：

2018 年度河北省医学科学研究重点课题（20181588）

摘要：

背景　目前，血肿特点与脑出血患者卒中后抑郁（PSD）的关系尚未完全明确。目的　探讨血肿特点与脑出血患者 PSD 的关系。方法　选取 2016 年 1 月—2017 年 6 月哈励逊国际和平医院收治的脑出血患者 166 例，剔除 20 例，根据 PSD 发生情况分为 PSD 组（n=66）和非 PSD 组（n=80）。比较两组患者性别、年龄、出血量、吸烟史、合并症（包括高血压、血脂异常、糖尿病）、美国国立卫生研究院卒中量表（NIHSS）评分及血肿部位（包括额叶、顶叶、颞叶、枕叶、基底核区、脑干及小脑），脑出血患者 PSD 影响因素采用多因素 Logistic 回归分析。结果　（1）本研究中 146 例脑出血患者 PSD 发生率为 45.2%，其中轻度抑郁者占 57.6%（38/66），中重度抑郁者占 42.4%（28/66）。（2）PSD 组患者出血量大于非 PSD 组，NIHSS 评分及左侧额叶血肿、左侧颞叶血肿、左侧基底核区血肿发生率高于非PSD 组（P<0.05）；两组患者男性比例、年龄、有吸烟史者所占比例及高血压、血脂异常、糖尿病、右侧额叶血肿、双侧顶叶血肿、右侧颞叶血肿、双侧枕叶血肿、右侧基底核区血肿、脑干血肿、小脑血肿发生率比较，差异无统计学意义（P>0.05）。（3）多因素 Logistic 回归分析结果显示，出血量〔OR=2.036，95%CI（1.315，3.149）〕、额叶血肿〔OR=1.732，95%CI（1.241，2.416）〕及颞叶血肿〔OR=1.795，95%CI（1.262，2.555）〕是脑出血患者 PSD 的独立影响因素（P<0.05）。结论　出血量、额叶血肿及颞叶血肿是脑出血患者 PSD 的独立影响因素，临床应针对出血量大、额叶血肿及颞叶血肿患者给予有针对性的干预措施以降低 PSD 发生风险。

Abstract：

Background　Relationship between characteristics of hematoma and post-stroke depression（PSD）in patients with cerebral hemorrhage has not been fully identified so far. Objective　To investigate the relationship betweencharacteristics of hematoma and PSD in patients with cerebral hemorrhage. Methods　A total of 166 patients with cerebralhemorrhage were selected in Harrison International Peace Hospital from January 2016 to June 2017，20 cases were excluded，and they were divided into PSD group（n=66）and non-PSD group（n=80）according to the incidence of PSD. Comparisonof gender，age，volume of bleeding，smoke history，incidence of combined diseases（including hypertension，dyslipidemiaand diabetes），NIHSS score and sites of hematoma（including frontal lobe，parietal lobe，temporal lobe，occipital lobe，basal ganglia area，brainstem and cerebellum）was made between the two groups，and influencing factors of PSD in patientswith cerebral hemorrhage was analyzed by multivariate Logistic regression analysis. Results　（1）Incidence of PSD was 45.2%in the 146 patients with cerebral hemorrhage in this study，thereinto mild depression accounted for 57.6%（38/66），moderateto severe depression accounted for 42.4%（28/66）.（2）Volume of bleeding in PSD group was statistically significantly morethan that in non-PSD group，NIHSS score as well as incidence of left frontal lobe hematoma，left temporal lobe hematoma andleft basal ganglia area hematoma in PSD group were statistically significantly higher than those in non-PSD group（P<0.05）；there was no statistically significant difference in male proportion，age，proportion of patients with smoking history，incidenceof hypertension，dyslipidemia，diabetes，right frontal lobe hematoma，bilateral parietal lobe hematoma，right temporallobe hematoma，bilateral occipital lobe hematoma，right basal ganglia area hematoma，brainstem hematoma or cerebellumhematoma between the two groups（P>0.05）.（3）Multivariate Logistic regression analysis results showed that，bleedingvolume〔OR=2.036，95%CI（1.315，3.149）〕，frontal lobe hematoma〔OR=1.732，95%CI（1.241，2.416）〕andtemporal lobe hematoma〔OR=1.795，95%CI（1.262，2.555）〕were independent influencing factors of PSD in patientswith cerebral hemorrhage（P<0.05）. Conclusion　Volume of bleeding，frontal lobe hematoma and temporal lobe hematomaare independent influencing factors of PSD in patients with cerebral hemorrhage，thus we should carry out targeted treatment forpatients with large volume of bleeding，frontal lobe hematoma or temporal lobe hematoma，to reduce the risk of PSD on clinic.

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