Effect Of Aromatherapy For Post Stroke Depressive Disorder In Participants

Objective: Patients may live with limb movement disorder,social maladjustment and reactive anxiety and depression after stroke.And it will initiate depression and anxiety with the abnormal release of 5-HT,NE and DA,which caused by the damage of brain and neuron.The incidence of post stroke depressive disorder is variable,ranging from 20% to 79%.It focus on the body function recovery and rehabilitation in clinic but less concern on the potential emotional dysfunction and sleep disorder which are also the key to influence patients' back to normal.It creates a fragrant and humid environment combining traditional aromatherapy and ward transformation theory and to explore the effect of aromatherapy for post stroke depressive disorder in patients which may be the evidence for ward construction,in addition to providing complementary and alternative therapy for intervention of post stroke depressive disorder in clinic and nursing.Method: 59 stroke participants hospitalized in the department of neurology of Hebei province from October 2015 to December 2016 were selected.Subjects were included when the diagnosis met the criteria of stroke for revision of the Forth National Conference on cerebrovascular diseases and confirmed by brain CT and MRI.In addition,samples should meet the criteria of post stroke depressive disorder reviewed by Psychosomatic medicine branch of Chinese Medical Association.HAMD scores ranged from 8 to 35 and HAMA scores ranged from 8 to 20 met the inclusion criteria.Patients should have a fixed family caregiver or company and signed the informed consent.Participants who had consciousness disorders,cognitive disorders,aphasia,dysarthria,deafness were excluded.Those who had a history of allergies,hormone,psychiatric disease and olfactory disorders were excluded.Subjects' general information was collected,including age,gender,education,payment of medical expenses,course of disease,age of onset,smoking and drinking history,history of hypertension and diabetes,cerebral infarction,the usage of antidepressant drugs,sleep drugs and olfactory nerve function etc.The included patients completed the assessment of Hamilton Depression Scale(24 edition),Hamilton Anxiety Scale(14 edition),Pittsburgh Sleep Quality Index(PSQI),modified Barthel Index,modified Rankin Score,National Institutes of Health Stroke Scale.The subjects were randomly divided into experiment group and control group.Patients received routine nursing care and suitable ward environment which the temperature was kept from 18? to22? and the relative humidity was kept from 50% to 60%.Patients were given health guidance and regular rehabilitation training.In the control group the diffuser which contained 100 ml distilled water distanced from nose from20 cm to 30 cm.The intervention was conducted for 30 minutes from 9 am to11 am every day lasting for 8 weeks.The experiment group received another 5drops essential oils on the basis of the intervention of the control group,mixing with 100 ml distilled water.The outcome measurements were assessed before intervention,2 weeks,4 weeks,6 weeks and 8 weeks after intervention.SPSS21.0 statistical software was used for statistical analysis.Quantitative data was described by Mean and Standard Deviation or Median(Inter-quartile Range).Hypothesis test was conducted by two independent sample t test or t'test or two independent sample rank sum test.Enumeration data was described by rate and percentage.Hypothesis test was explored by Chi Square test.Repeated measurement of variance was conducted for the hypothesis test of the repeated measurement data.Results: The results of the internal consistency evaluation show that the internal consistency of the two raters is better with ? > 0.70.Each stroke position was defined as an independent variable and the frequency of each part occurrence was counted.The results of stroke position show that there are 96 stroke positions of the subjects.Bilateral basal ganglia(29/96)is the highest frequency of stroke,next is left occipital leaf(12/96),followed by left frontal lobe(8/96),right parietal lobe(8/96),right occipital lobe(8/96),right basalganglia(6/96),bilateral frontal parietal lobe(5/96),periventricular(4/96),multiple infarcts(3/96),left basal ganglia(3/96),left temporal lobe(2/96),left insula(1/96),bilateral insula(1/96),brain stem(1/96),pons(1/96),bilateral coronal radiation(1/96),bilateral frontal(1/96),left basal ganglia(1/96),right temporal parietal occipital lobe(1/96).The analysis of variance results of two groups HAMD repeated measurement data show that correction coefficient is0.468,and there is significant difference before and after intervention at different time(F=454.659,P < 0.001).The difference is significant in the experiment(F=219.977,P<0.001)and control(F=245.419,P<0.001)group before and after intervention between different time.The scores comparison of two groups at different time is statistically significant at 2 weeks(F=5.279,P=0.025),4 weeks(F=21.841,P < 0.001),6 weeks(F=9.381,P=0.003),8weeks(F=11.101,P=0.002)after intervention.There is a downward trend over time at the two groups of the HAMD scores,but the scores of the two groups are not less than 8 points.The scores decreased rate in the experiment group is higher than in the control group from initial trial to 4 weeks after intervention.The post hoc comparison of 2-week,4-week,6-week in the experiment group show that the difference is significant(P < 0.05)and the difference is not significant between 6-week and 8-week(P>0.05).The post hoc comparison in the control group show that there is significant difference before and after intervention(P<0.05),4-week and 6-week(P<0.05).And the difference is not significant between 2-week and 4-week(P>0.05),6-week and 8-week(P>0.05).The comparison of HAMD scores in the two groups show that the difference is statistically significant(F=10.125,P=0.002).Totally the scores in the experiment group is lower than the control group.And there is interaction between time factor and group factor(F=8.326,P=0.001).There is no significant difference before and after intervention(P>0.05).The difference is statistically significant at 2 weeks after intervention(P < 0.05)and the scores in the experiment group in higher than the control group.The difference is statistically significant at 4-week,6-week and 8-week after intervention(P<0.05)and the scores in the experiment group in lower thanthe control group.The depressive symptoms have been improved over time and the intervention can help to promote the symptoms relief.The analysis of variance results of two groups HAMA repeated measurement data show that correction coefficient is 0.697,and there is significant difference before and after intervention at different time(F=112.952,P < 0.001).The difference is significant in the experiment(F=64.132,P<0.001)and control(F=50.150,P<0.001)group before and after intervention between different time.The scores comparison of two groups at different time is no statistically significant at 2 weeks(F=0.453,P=0.503),and the difference is significant at 4 weeks(F=4.211,P=0.045),6weeks(F=14.584,P < 0.001),8 weeks(F=39.979,P < 0.001)after intervention.There is upward first and downward then trend over time at the two groups of the HAMA scores,and the scores of the experiment group are less than 7 points at 6 weeks after intervention,the control group at 8 weeks.The scores increased rate in the experiment group is higher than in the control group from initial trial to 2 weeks after intervention and the scores decreased rate in the experiment group is higher than in the control group from 2 weeks after intervention.The post hoc comparison of before and 2-week,6-week,8-week after intervention in the experiment group show that the difference is significant(P < 0.05)and the difference is not significant between before and 2-week(P>0.05)and between 2-week and 4-week after intervention(P>0.05).The post hoc comparison in the control group show that there is significant difference before and after intervention(P<0.05).And the difference is not significant between before and 6-week after intervention(P>0.05),2-week and 4-week(P>0.05).The comparison of HAMA scores in the two groups show that the difference is statistically significant(F=14.363,P<0.001).In total,the effect of experiment group is better than the control group at 4 weeks after intervention.And there is interaction between time factor and group factor(F=6.612,P < 0.001).The anxiety symptoms have been changed over time and the intervention can help to relieve participants' anxiety.The analysis of variance results of two groups PSQI repeatedmeasurement data show that correction coefficient is 0.605,and there is significant difference before and after intervention at different time(F=233.397,P < 0.001).The difference is significant in the experiment(F=112.361,P<0.001)and control(F=128.239,P<0.001)group before and after intervention between different time.The scores comparison of two groups at different time is statistically significant at 4 weeks(F=6.100,P=0.017),8 weeks(F=17.729,P < 0.001)after intervention.There is a downward trend over time at the two groups of the PSQI scores,and the scores of the experiment group are less than 5 points.The post hoc comparison results show that the difference is significant(P<0.05)in each two time.The comparison of PSQI scores in the two groups show that the difference is statistically significant(F=3.081,P=0.085).And there is no interaction between time factor and group factor(F=4.564,P=0.029).The depressive symptoms have been improved over time in two groups,but there is no significant difference.The HAMD scores reduction rate which is higher than50% is regarded effective.The results of effect show that 79.3% are valid in the experiment group and 53.3% are valid in the control group.The difference between two groups is significant(?2=4.441,P=0.035).Conclusions: The incidence of post stroke depressive disorder is related to the location of stroke.Bilateral basal ganglia,left occipital and left frontal lobe are the high frequency location in the trial.Aromatherapy can significantly improve post stroke depressive symptoms and anxiety.The aromatherapy may be effective for post stroke depressive disorder after 4-week intervention and be useful for anxiety at 6 weeks after intervention.But it cannot help participants to improve sleep condition.