急性期脑卒中患者卒中后抑郁的潜在类别及护理启示

doi:10.3761/j.issn.0254-1769.2025.07.003

摘要/Abstract

摘要：

目的探讨急性期脑卒中患者卒中后抑郁的潜在类别及其与神经功能缺损程度的相关性，为临床医护人员制订针对性的干预措施提供参考。方法采用便利抽样法，选取2024年1月—4月在河南省2所三级甲等综合医院神经内科住院的193例急性期脑卒中患者作为调查对象，使用一般资料调查表、美国国立卫生院卒中量表和患者健康问卷进行调查。采用无序多分类Logistic回归分析卒中后抑郁潜在类别与神经功能缺损程度的相关性。结果 193例急性期脑卒中患者卒中后抑郁得分为（10.22±3.61）分，卒中后抑郁可分为低抑郁症状组（44.6%）、忧郁型抑郁组（15.0%）、非典型抑郁组（40.4%）3个潜在类别，不同潜在类别脑卒中患者的神经功能缺损程度差异具有统计学意义（P<0.001），与重度神经功能缺损相比，轻度缺损患者更可能归于“忧郁型抑郁组”（OR=0.016，P=0.001）和“非典型抑郁组”（OR=0.040，P<0.001），中度缺损患者更可能归于“非典型抑郁组”（OR=0.085，P=0.001）。结论急性期脑卒中患者卒中后抑郁存在明显的分类特征，建议医护人员应加大对不同神经功能缺损程度患者的关注，根据卒中后抑郁的不同类别采取针对性的干预措施以减轻其抑郁症状。

关键词: 急性期, 脑卒中, 卒中后抑郁, 潜在类别分析, 神经功能缺损程度, 护理

Abstract:

Objective To explore potential categories of post-stroke depression in acute-phase stroke patients and its correlation with the degree of neurological deficits，and to provide references for healthcare professionals in developing targeted interventions. Methods Using convenience sampling，patients with acute stroke who were hospitalized in neurological ward of 2 tertiary general hospitals in Henan Province from January to April 2024 were selected as the survey participants. The investigation was conducted using the General Information Questionnaire，the National Institute of Health Stroke Scale，and the Patient Health Questionnaire-9. The correlation between potential categories of post-stroke depression and the degree of neurological deficit was analysed using unordered multiclassified logistic regression. Results Post-stroke depression score was 10.22±3.61 in 193 acute-phase stroke patients，and post-stroke depression could be categorized into 3 potential categories，namely“low depressive symptoms”（44.6%），“melancholic depression”（15.0%），and “atypical depression”（40.4%）. There was a significant difference in the degree of neurological deficits（H=38.074，P<0.001）.Compared with severe neurological deficits，patients with mild deficits were more likely to be categorized as “melancholic depression”（OR=0.016，P=0.001） and “atypical depression”（OR=0.040，P<0.001），and patients with moderate deficits were more likely to be classified as “atypical depression”（OR=0.085，P=0.001）. Conclusion Post-stroke depression in acute-phase stroke patients has obvious categorization characteristics，and it is recommended that healthcare professionals should pay more attention to patients with different degrees of neurological deficits and adopt targeted interventions according to the different categories of post-stroke depression in order to alleviate their depressive symptoms.

Key words: Acute Phase, Stroke, Post-Stroke Depression, Latent Category Analysis, Degree of Neurological Deficit, Nursing Care

苏炫, 成巧梅, 李晓婉, 王珂心, 王培席, 肖梦伟, 王语, 李楠楠, 谢丹莹. 急性期脑卒中患者卒中后抑郁的潜在类别及护理启示[J]. 中华护理杂志, 2025, 60(7): 785-791.

SU Xuan, CHENG Qiaomei, LI Xiaowan, WANG Kexin, WANG Peixi, XIAO Mengwei, WANG Yu, LI Nannan, XIE Danying. Study on the latent classes of post-stroke depression in patients with acute stroke and nursing insights[J]. Chinese Journal of Nursing, 2025, 60(7): 785-791.

图/表 5

表1 卒中后抑郁潜在类别分析模型拟合指标（n=193）

Table 1 Model fitting indicators for potential category analysis of post-stroke depression（n=193）

图1 卒中后抑郁的3个潜在类别的条件概率分布情况

Figure 1 Conditional probability distributions for 3 potential categories of post-stroke depression

表2 不同卒中后抑郁类别患者的单因素分析结果[例（百分比， %）]

Table 2 Univariate analysis results of patients with different categories of post-stroke depression[case（percentage，%）]

表3 不同卒中后抑郁类别的脑卒中患者神经功能缺损程度的得分比较[分，M（P25，P75）]

Table 3 Comparison of scores of neurological impairment in stroke patients with different types of post-stroke depression[score，M（P25，P75）]

表4 卒中后抑郁潜在类别的多元Logistic回归分析（n=193）

Table 4 Multiple Logistic regression analysis of potential categories of post-stroke depression（n=193）

参考文献 25

[1]	王少石, 周新雨, 朱春燕. 卒中后抑郁临床实践的中国专家共识[J]. 中国卒中杂志, 2016, 11(8):685-693.
	Wang SS, Zhou XY, Zhu CY. China expert consensus on clinical practice of post-stroke depression[J]. Chin J Stroke, 2016, 11(8):685-693.
[2]	李清金, 韩玉惠, 洪春永, 等. 基于抑郁程度、心理痛苦、自理能力分析的脑卒中后抑郁患者自杀倾向的影响因素探讨[J]. 临床误诊误治, 2024, 37(5):23-28.
	Li QJ, Han YH, Hong CY, et al. Influential factors of suicide tendency in post-stroke depression patients based on analysis of depression severity,psychological distress,and self-care ability[J]. Clin Misdiagn Misther, 2024, 37(5):23-28.
[3]	Zeng YY, Wu MX, Geng DD, et al. Early-onset depression in stroke patients:effects on unfavorable outcome 5 years post-stroke[J]. Front Psychiatry, 2021, 12:556981.
[4]	Duncan PW, Zorowitz R, Bates B, et al. Management of adult stroke rehabilitation care:a clinical practice guideline[J]. Stroke, 2005, 36(9):e100-e143.
[5]	曹娟, 李秀华, 殷金娇, 等. 缺血性脑卒中患者急性期抑郁状态及相关因素分析[J]. 潍坊医学院学报, 2022, 44(2):146-148.
	Cao J, Li XH, Yin JJ, et al. Analysis of psychological status and related factors in patients with is chemic stroke at acute stage[J]. J Weifang Med Coll, 2022, 44(2):146-148.
[6]	Meng GL, Ma XY, Li L, et al. Predictors of early-onset post-ischemic stroke depression:a cross-sectional study[J]. BMC Neurol, 2017, 17(1):199.
[7]	Deng MZ, Zhou NN, Song KP, et al. Higher homocysteine and fibrinogen are associated with early-onset post-stroke depression in patients with acute ischemic stroke[J]. Front Psychiatry, 2024, 15:1371578.
[8]	温忠麟, 谢晋艳, 王惠惠. 潜在类别模型的原理、步骤及程序[J]. 华东师范大学学报(教育科学版), 2023, 41(1):1-15. DOI
	Wen ZL, Xie JY, Wang HH. Principles,procedures and programs of latent class models[J]. J East Chin Norm Univ(Educ Sci Edit), 2023, 41(1):1-15.
[9]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9):710-715.
	Chinese Medical Association Society of Neurology & Cerebro vascular Disease Section. Diagnostic criteria of cerebrovascular diseases in China(version 2019)[J]. Chin J Neurol, 2019, 52(9):710-715.
[10]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性卒中诊治指南2023[J]. 中华神经科杂志, 2024, 57(6):523-559.
	Chinese Medical Association Society of Neurology & Cerebro vascular Disease Section. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2023[J]. Chin J Neurol, 2024, 57(6):523-559.
[11]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation hi quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[12]	Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction:a clinical examination scale[J]. Stroke, 1989, 20(7):864-870. DOI PMID
[13]	蔡业峰, 贾真, 张新春, 等. 美国国立卫生院卒中量表(NIHSS)中文版多中心测评研究:附537例缺血中风多中心多时点临床测评研究[J]. 北京中医药大学学报, 2008, 31(7):494-498.
	Cai YF, Jia Z, Zhang XC, et al. Study on multi-center investigation of the Chinese version of National Institutes of Health Stroke Scale[J]. J Beijing Univ Tradit Chin Med, 2008, 31(7):494-498.
[14]	Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD:the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire[J]. JAMA, 1999, 282(18):1737-1744.
[15]	郑婷, 石玉芝, 张宁, 等. 病人健康问卷-9在卒中抑郁患者中的信度和效度研究[J]. 北京医学, 2013, 35(5):352-356.
	Zheng T, Shi YZ, Zhang N, et al. Reliability and validity of PHQ-9 in patients with post-stroke depression[J]. Beijing Med J, 2013, 35(5):352-356.
[16]	钟小路, 郝巧蓉, 汪应瑞, 等. 老年脑卒中后抑郁状况评估及其相关因素分析[J]. 现代预防医学, 2020, 47(3):474-478.
	Zhong XL, Hao QR, Wang YR, et al. The evaluation and influencing factors of post-stroke depression in the elder patients[J]. Mod Prev Med, 2020, 47(3):474-478.
[17]	American Psychiatric Association D, American Psychiatric As-sociation. Diagnostic and statistical manual of mental disor-ders:DSM-5[M]. Washington,DC: American Psychiatric Associa-tion, 2013.
[18]	Kauhanen M, Korpelainen JT, Hiltunen P, et al. Poststroke depression correlates with cognitive impairment and neurological deficits[J]. Stroke, 1999, 30(9):1875-1880. DOI PMID
[19]	郭玉清, 王少敏, 赵蓓, 等. 心理韧性在领悟社会支持与卒中后抑郁症状间的中介效应研究[J]. 中国慢性病预防与控制, 2024, 32(4):299-302.
	Guo YQ, Wang SM, Zhao B, et al. Psychological resilience’s mediating effect on understanding social support and post-stroke depression symptoms[J]. Chin J Prev Contr Chronic Dis, 2024, 32(4):299-302.
[20]	鲍金雷, 杨庆爱, 张俊, 等. 脑卒中半失能老年患者复发恐惧的调查研究[J]. 中华护理杂志, 2021, 56(11):1661-1666. DOI URL
	Bao JL, Yang QA, Zhang J, et al. Risk factors of stroke and fear of stroke recurrence in elderly stroke patients with semi disability[J]. Chin J Nurs, 2021, 56(11):1661-1666. DOI URL
[21]	Selvaraj S, Aggarwal S, de Dios C, et al. Predictors of suicidal ideation among acutestroke survivors[J]. J Affect Disord Rep, 2022, 10:100410.
[22]	Choi JW, Lee SG, Kim TH, et al. Poststroke suicide risk among older adults in South Korea:a retrospective longitudinal cohort study[J]. Int J Geriatr Psychiatry, 2020, 35(3):282-289.
[23]	林蓓蕾, 郭云飞, 张振香, 等. 脑卒中患者疾病体验及其复发风险感知的质性研究[J]. 中华护理杂志, 2021, 56(1):80-85. DOI URL
	Lin BL, Guo YF, Zhang ZX, et al. A qualitative study on disease experience and recurrence risk perception of stroke survivors[J]. Chin J Nurs, 2021, 56(1):80-85. DOI URL
[24]	Diefenbach GJ, Rudd MD, Merling LF, et al. Brief cognitive-behavioral therapy for suicidal inpatients[J]. Cogn Behav Pract, 2021, 28(2):224-240.
[25]	张傲, 赵培玉, 胡楠楠, 等. 脑卒中患者积极心理体验质性研究的Meta整合[J]. 中华护理杂志, 2022, 57(5):617-624. DOI URL
	Zhang A, Zhao PY, Hu NN, et al. Positive psychological experience of stroke patients:a qualitative meta-synthesis[J]. Chin J Nurs, 2022, 57(5):617-624.