| Part ?:The Analysis of Prevalence and Associated Risk Factors of Depression in Patients with Dysphagia after Stroke.Objective To investigation the incidence and associated risk factors of depression in patients with dysphagia after strokeMethodl.Two hundreds and forty in-hospitalized patients and outpatient whose disease course ranged from 14d to 180d poststroke were prospective investigated, including 120 cases with dysphagia in the observation group (group A), Two hundreds and 120 cases without dysphagia as control group (group B).2. The demographic data, medical history and clinical data of observation group (group A) were collected And their swallowing function score and depression scale were assessed. According to the Depression Scale scores,all patients were divided into normal group (< 8 score) and depression group (8-35 score). The incidence and associated risk factors of depression of patients in group A was analysized. The demographic data and clinical data were compared between the two groups. And the depression group were divided into mild depression group (8-20 score), moderate depression group (21?35 score) and severe depression group (>35 score).The relationship of the degree of depression and swallowing function score. Was analysized.3. Hamilton Depression Scale (HAMD) were used to evaluate the depressive state of patients in the control group (B group). According to the scores, patients were divided into normal group (< 8 score) and depression group (8-35 score).Resultl.The rate of PSD of patients in group A group was 70.83%, with higher incidence compared with the control group (group B) (40.83%). In group A, mild depression was 15.8%, moderate depression and severe depression was 34.7%(15.2%).2.The total cases of depression with swallowing function 2-5 grade were 11,16, 23 and 36.The number of cases of severe depression were 3,4,8 and 14 cases, therefore, the higher of the level of dysphagia, the higher incidence of depression.3. Single factor of the differences in demographic data and history of patients was analysized. There was significant difference between two groups is:a history of diabetes (P=0.036), brainstem stroke (P=0.021), complications (P=0.046), character (impatient) (P<0.001), caregiver type (non fixed) (P=0.032); There was no significant difference between the two groups are:age, gender (P=0.25) (P=0.92), marital status (P=0.202) (P=0.89), living conditions, occupation status (P=0.794), medical insurance type (P=0.876) and culture degree (P,=0.857) the type of stroke (P =0.899). There was significant difference between two groups is:a history of diabetes (P=0.036), brainstem stroke (P=0.021), complications (P=0.046), character (impatience) (P< 0.001), caregiver type (non fixed) (P=0.032); There was no significant difference between the two groups are:age, gender (P=0.25) (P=0.92), marital status (P=0.202) (P=0.89), living conditions, occupation status (P=0.794), medical the type of insurance (P=0.876), culture (P=0.857), degree of stroke type (P =0.899). The proportion of patients with complications, a history of diabetes and irritable and non fixed caregivers in depression group was higher than that in normal group.4. The results of independent risk factors by multi factor Logisitic analysis were: the character type:the partial regression coefficient of standard deviation of B=0.851; S=0.084; Wald=7.537; freedom Df=1; relative risk OR=2.341; 95% confidence interval 95%CI CI (1.985,2.761), P=0.006. The caregiver is not fixed:partial regression coefficient of standard deviation of B=0.704; S=0.067; Wald=4.982; freedom Df=1; relative risk OR=0.4951; 95% confidence interval 95%CI CI (0.433, 0.564), P=0.026. Diabetes:the partial regression coefficient of standard deviation of B=0.842; S=0.049; Wald=7.011; freedom Df=1; relative risk OR=2.321; 95% confidence interval 95%CI CI (2.11,2.554), P=0.008; complications:partial regression coefficient of standard deviation of B=1.066; S=0.125; Wald=8.063; freedom Df=1; relative risk OR=2.903; 95% confidence interval 95%CI CI (2.273, 3.708), P=0.005.Conclusion More than 70% of patients suffered varying degrees of depression in patients with dysphagia poststroke. The rate of PSD is higher than that of stroke patients without dysphagia. Impatience, diabetes, complications are independent risk factors for depression, fixed the caregiver is a protective factor for depression.Part ?. The Effect of Depression on The Rehabilitation of Dysphagia in Poststroke PatientsObjective To investigate the effect of depression on the restoration of swallowing function in patients poststroke with dysphagia.Methods Sixty patients with dysphagia after stroke was divided into 4 groups according to the Hamilton Depression Scale (HAMD):group A (15 cases) (HAMD score <8 score), group B for mild depression (16 cases) (HAMD score of 8 to 20), group C for moderate depression (HAMD score 21-35) (16 cases), group D for severe depression (score of HAMD>35) (13 cases), The wallowing rehabilitation and SWAL-QOL score were analyzed respectively,in patients before and 30 days after treatment.Result1.In group A, the score of swallowing function of patients before treatment was 2.88± 0.63,30 days after treatment, swallowing function score was 9.24±0.35, compared before and after treatment (P<0.001).The difference was statistically significant; Swallowing function score of patients in group B before treatment, was 2.87±0.65.Thirty days after treatment, swallowing function score was 7.21±0.36, compared before and after treatment (P<0.001),which difference was statistically significant; The wallowing function score patients in group C before treatment was 3.36±0.58, By 30 days after treatment,Swallowing function score was 3.66±0.40.There was no statistically significant difference before and after treatment (P=0.091); Swallowing function of patients in group D was 2.75±0.63 before treatment, By 30 days after treatment, swallowing function score was 3.05±0.35.There was no significant difference between before and after treatment (P=0.146).2. The results of specific quality of life scale score (SWAL-QOL) in four groups of patients with dysphagia:before treatment SWAL-QOL score were 92.18±17.55, 92.17±18.15,93.05±17.86,93.15±17.56,30 days after treatment were 158.15± 19.65,155.45±18.65,115.56±17.58,105.56±17.58, moderate depression group and severe depression group before and after treatment, P> 0.05, there was no significant difference after treatment;,there was significant differences between mild to moderate depression and severe depression group after treatment.Conclusion There are obvious negative effects on swallowing function rehabilitation and quality of life in patients with severe depression and dysphagia poststroke.Part ?. Studys on Intervention for Dysphagia after Stroke Complicated with DepressionObjective To observe the effect of psychological intervention combined anti-depression drugs on dysphagia after stroke complicated with depression.Methods 65 patients with acute stroke and patients with moderate depression were randomly divided into 3 groups, A group (22 cases), B group (21 cases), C group (22 cases). The scores of depression and swallowing function were analyzed before and after 2 weeks,4 weeks,12 weeks after treatment, respectively.ResultsThere was no significant difference in the degree of depression in the first 3 groups (P>0.05); there was no significant difference between 2 weeks,4 weeks,12 weeks and weeks after treatment, while the scores of depression in antidepressant group were 18.2±2.2,15.2±2.2,5.66±0.40, The difference was statistically significant (P< 0.05), respectively, in the control group and the psychological intervention group;There was no significant difference between the 3 groups before treatment (P> 0.05); there was no significant difference between the 2 and weeks,4 weeks and 12 weeks after treatment, while the swallowing function score of the antidepressant drugs group was 7.86±0.40,8.81±0.62,9.24±0.55, There were statistically significant differences between the control group and the psychological intervention group at the same time point (P<0.05).Conclusion The implementation of psychological intervention can not improve the degree of depression and swallowing function of patients with moderate to severe depression. The antidepressant drugs can improve the degree of depression in patients with moderate to severe depression, and can improve the effect of rehabilitation treatment of swallowing function. |
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