| BackgroundPost-stroke depression (PSD) is one of the common complications after stroke and the mood disorder which is mainly featured by sustained low emotion and, wanned interest after stroke. Diagnosis of PSD must have the preconditions of stroke and be consistent with the diagnostic criteria of depression. Currently the U.S Statistical Manual of Mental Disorders 4th edition (DSM-Ⅳ) and International Classification of Disease 10th Revision (ICD-10) are used as qualitative diagnostic criteria in abroad, while Chinese classification and diagnosis of mental disorder III (CCMD-3) is used as qualitative diagnostic in china. The Hamilton depression scale (HAMD), Zung self-rating depression scale (SDS) and the Beck depression inventory (BDI) are often used as Quantitative diagnostic criteria.There is a higher morbidity of PSD. It not only prevents patients'neurological and cognitive function from recovering, affects their quality of life and prognosis, increases mortality, brings patients physical and mental pain, but also increases the burden on patients'family and the total society. Currently, PSD is focus of neurology and psychiatric department. Most reseach on PSD in china and other coutries focus on its incidence, pathogenesis, related factors and treatment. Because the researcher used different methods, conclusions were quite different.The minimally invasive hematoma stereotactic aspiration is a method developed in recent years that was used to treat intracerebral hemorrhage. Many studies show that it can be faster in promoting recovery of patients'neurological function and improving the quality of life and prognosis of patients with intracerebral hemorrhage than the conservative treatment. Then can it reduce the incidence of depression after intracerebral hemorrhage?In our issue, we use patients with intracerebral hemorrhage as research subject. In order to offer help to the early diagnosis and intervention to depression after intracerebral hemorrhage, we identify risk factors on depression after intracerebral hemorrhage by analysis of a variety of its related factors. Through comparison of the impact on incidence of depression after intracerebral hemorrhage within 3 months treated by the minimally invasive hematoma stereotactic aspiration therapy and medical conservative treatments, we explore the feasibility of reducing the incidence of depression after intracerebral hemorrhage by early intervention in order to promote recovery of neurological function in patients with intracerebral hemorrhage.An analysis of risk factors of depression after intracerebra hemorrhageObjective1 To explore the prevalence of depression after intracerebral hemorrhage in the 14th day, the 90th day after onset and the total incidence of depression after intracerebral hemorrhage during the 90 days after onset after intracerebral hemorrhage, and their composition.2 To seek risk factors for depression after intracerebral hemorrhage by an analysis of multiple related factors of depression after intracerebral hemorrhage. We expect to provide some help of the early prevention and treatment of depression after intracerebral hemorrhage.Methods1 Case materials collection methods:The first stroke inpatients with intracerebral hemorrhage were recruited in Nanfang Hospital in Guangzhou city from December 2007 to December 2009. Total 101 patients were investigated, but in the end 93 patients fufiled all investigations. Among these patients, all patients are right-handed. All patients met the diagnostic criteria for intracerebral hemorrhage edited at the 4th national academic conference on cerebrovascular disease hosted by Chinese Medical Association, and had brain CT examination and revealed intracerebral hemorrhage.2 Inclusion criteria:All patients'age were not less than 18 years; it is within 14 days from the occurrence of intracerebral hemorrhage to the hospital.3 Exclusion criteria:All patients did not meet the inspection and investigation because they had serious obstacles of listening, speaking or understanding; All patients with severe heart and respiratory failure or other serious physical illness did not meet the inspection and investigation; All patients were those who do not want to follow up and survey.4 Clinical data collection: All enrolled patients were recorded in their hospital to complete their gender, age, education level, marital status, habitation, intracranial hemorrhage volum on admission, hemorrhage location, hemorrhage into cerebral ventricles, midline shift, the values of the Nation Institutes of Health Stroke Scale (NIHSS) on admission, history of depression, hypertension, diabetes, dyslipidemia, coronary heart disease, smoking and alcohol history.5 Evaluation methods and group:At the 14th day and 90th day after onset, the 13-item Beck depression inventory (BDI-13) was used to screen depressive patients, if the scores of BDI-13≥5, the 17-item Hamilton depression scale (HAMD-17) was applied to evaluate the depression of the patients:the scores of HAMD-17<8, no depression; 17> the scores of HAMD-17≥8 points, mild depression; 24> the scores of HAMD-17≥17, moderate depression; the scores of HAMD-17≥24, severe depression. If the patients'HAMD-17 scores≥8 and consistented with the diagnostic criteria of depression in CCMD-3, they could be diagnosed depression after intracerebral hemorrhage. The patients diagnosed depression after intracerebra were listed as the depression group, the rest were non-depressed group.The Modified Rankin Scale (mRS) was used to evaluate the extent of the physical disability and the HAMD was applied to evaluate the depression of the patients at the 90th day after onset.Results1 The incidence and composition of depression after intracerebral hemorrhage:The incidence and composition of depression after intracerebral hemorrhage in 14th day after onset:there were 7 patients who had depression after intracerebral hemorrhage among total patients, the prevalence of the post-stroke depression was 7.53%. Major depression was 5cases, moderate depression was 1 case, and severe depression was 1 case; the incidence and composition of depression after intracerebral hemorrhage in 90th day after onset:there were 24 patients who had depression after intracerebral hemorrhage in total patients, the prevalence of the post-stroke depression was 25.81%. Major depression was13 cases, moderate depression was 8 cases, and severe depression was 3 cases; the total incidence and composition of depression after intracerebral hemorrhage during the 90 days after onset:there were 31 patients who had depression after intracerebral hemorrhage in total patients, the prevalence of the depression after intracerebral hemorrhage was 7.53%. Major depression was diagnosed in 58.06%(n=18), moderate depression in 29.03%(n=18), and severe depression in 12.90%(n=4).2 Analysis of biological factors:The intracranial hemorrhage volum on admission in depression group was(21.65±10.73) ml, but that of non-depression group was (16.567±10.87) ml. There was statistically significant difference between the two groups (t= 2.136, P= 0.035)It was statistically significant difference that the proportion of the hemorrhage into cerebral ventricles in the depression group was higher than that in non-depression group (x2=4.511,P=0.035).Compared with the non-depression group, the proportion of the midline shift in the depression group was higher (x2=4.567,P=0.033).The values of NIHSS on admissionin the depression group (16.97±4.05) were higher than those in the non-depression group (13.47±6.07), the difference was statistically significant (t=3.300, P=0.001); there was statistically significant difference between the depression group (2.94±8.89) and the non-depression group(1.63±0.96) in the mRS values in the 90th day after onset (t=6.321, P=0.000).The dyslipidemia in the depression group is higher than that in non-depression group, the difference had statistically significance (x2=4.968, P=0.026). There was no statistically significant difference in hemorrhage location (x2=0.000, P=1.000), hypertension (x2=0.000, P=1.000), coronary heart disease (x2=3.219, P=0.073), diabetes (x2=0.042, P=0.838), smoking (x2=0.253, P=0.615) and alcohol history (x2=0.604, P=0.437) between the depression group and the non-depression group.3 Analysis of social and psychological factors:It was statistically significant difference that the proportion of female in the depression group was higher compare with the non-depression group (x2=6.098, P=0.014).The age in the depression group was (61.16±9.59) years, which is older than that in the non-depression group is (56.40±10.44) years. The difference was statistically significance (t=2.127,P=0.036).The proportion of no spouse in the depression group was larger that in the non-depression group. The difference was statistically significance (x2=6.482, P=0.011).The proportion of the history of depression in the depression group was larger than that in the non-depression group, and the difference was statistically significance (x2=5.296,P=0.021).There was no difference in the education level (x2=1.966,P=0.161) and habitation (x2=0.022, P=0.882) between the depression group and the non-depression group.4 Logistic regression analysis showed that the hemorrhage into cerebral ventricles, the values of the NIHSS on admission, the values of the mRS, dyslipidemia, gender, marital status are significant factors of depression after the intracerebral hemorrhage.Conclusions 1 Depression after intracerebral hemorrhage is a common complication of intracerebral hemorrhage, and the incidence of depression after intracerebral hemorrhage was 33.33% during the 3 months after onset. Most depression after intracerebral hemorrhage was mild and moderate depression, Major depression was less.2 The hemorrhage into cerebral ventricles, dyslipidemia, female and non-spouses were risk factors for depression. The higher the values of NIHSS and mRS was, the greater of the occurrence of depression after intracerebral hemorrhage was.3 In this study, by univariate analysis it did not find that depression after intracerebral hemorrhage is related with hemorrhage location, hypertension, coronary heart disease, diabetes, smoking and alcohol history, education level, habitation. Although the difference in hemorrhage volum, midline shift, age, history of depression was significant between the depression group and the non-depression group, the regression equation analysis did not found that they were significant factors of depression after intracerebral hemorrhage.Clinical reseach on the effect of minimal invasive hematoma stereotactic aspiration on the incidence of depression after intracerebral hemorrhageObjectiveTo explore the impact of minimal invasive hematoma stereotactic aspiration of intracerebral hematoma on the neurological deficits and the incidence of depress afterintracerebral hemorrhage by a perspective research between the patients with intracerebral hemorrhage treated with the minimal invasive hematoma stereotactic aspiration therapy and the medical conservative treatments.Methods1 Case materials collection methods:The first stroke inpatients with intracerebral hemorrhage were recruited in Nanfang Hospital in Guangzhou city from December 2007 to December 2009. Among these inpatients,26 patients with intracerebral hemorrhage treated with the stereotactic minimal invasive hematoma Clearing therapy were enrolled into the stereotactic group.32 patients treated with the conservative treatments were enrolled into the conservative group (control group). All patients are right-handed. All patients met the diagnostic criteria for intracerebral hemorrhage edited at the 4th national academic conference on cerebrovascular disease hosted by chinese medical association, and had brain CT examination and revealed cerebral hemorrhage.2 Inclusion criteria:All patients'age were not less than 18 years; all patients were admitted to hospital within 24 hours from the onset of cerebral hemorrhage to patients diagnosed; hemorrhage location were the basal ganglia, cerebral lobes, thalamus; intracranial hemorrhage volum were not less than 5 ml; muscle strength was equal or less than the second level or the patients had disorder of consciousness.3 Exclusion criteria:All patients had a history of depression; All patients with re-hemorrhage, brain stem hemorrhage, cerebellar hemorrhage, traumatic hemorrhage were not included; All patients did not meet the inspection and investigation because they had serious obstacles of listening, speaking or understanding;All patients with severe heart and respiratory failure or other serious physical illness did not meet the inspection and investigation; All patients were those who did not want to follow up and survey.4 Clinical data collection:All enrolled patients were recorded in their hospital to complete their gender, age, intracranial hemorrhage volum on admission, hemorrhage location, hemorrhage into cerebral ventricles, midline shift, the values of the neurological deficits evaluated by the NIHSS on admission, hypertension, diabetes, dyslipidemia, coronary heart disease, smoking and alcohol history.5 Evaluation methods and group:The NIHSS was applied to evaluate the neurological deficits at the 14th day and the 90th day after onset respectively. The decreased values of the NIHSS were counted at the 14th day and the 90th day after onset respectively. (All were compared with the values of the NIHSS evaluated at the admission of the patientsThe mRS was used to evaluate the extent of the physical disability at the 90th day after onset.The BDI-13 and HAMD-17 were applied to evaluate the depression of the patients at the 14th day and the 90th day after onset:the scores of HAMD-17<8, no depression; 17>the scores of HAMD-17≥points, mild depression; 24> the scores of HAMD-17≥17, moderate depression; the scores of≥24, severe depression. If the patients'HAMD-17 scores≥8 and consistented with the diagnostic criteria of depression in CCMD-3, they could be diagnosed as depression after intracerebral hemorrhage. The patients diagnosed depression after intracerebra were listed as the depression group, the rest were non-depressed group.The decreased values of NIHSS between the stereotactic group and the conservative group were respectively compared at the 14th day and the 90th day after onset. The values of mRS between the stereotactic group and the conservative group were compared the 90th day after onset.The incidence of depression after intracerebral hemorrhage in the 14th and 90th day after onset and the total incidence of depression after intracerebral hemorrhage during the 90 days after onset were respectively compared between the stereotactic group and the conservative group.The values of NIHSS both inl4th day and the 90th day after onset were respectively compared with between non-depressed group and depression group.The correlation between the values of NIHSS and the values of HAMD-17 was analyzed both in the 14th days and the 90th day after onset, The correlation between the of values mRS and the values of HAMD-17 was analyzed in the 90th days after onset, the relationship between PSD and the extent of the neurological deficits and the physical disability was analysed.Results1 There was no significant difference in their age, gender, intracranial hemorrhage volum, hemorrhage location, hemorrhage into cerebral ventricles, midline shift, the values of NIHSS on admission and cerebral vascular disease risk factors between the stereotactic group and the conservative group (P>0.05).2 The decreased values of NIHSS in the stereotactic group were (6.96±2.56) and those of the conservative group were (5.22±1.66) in the 14th day after onset, There was significant difference between the two group (t=2.976, P=0.005). The decreased values of NIHSS of the stereotactic group was (14.81±2.71) and those of conservative group was (11.22±2.45) in 90th day after onset, There was significant difference between them (t=5.292, P=0.000).3 The values of mRS of the stereotactic group were (2.23±0.82) in 90th day after onset, but those of the conservative group were (2.84±0.920). There was significant difference between them (t=-2.655, P=0.010)4 There was no significant difference in the incidence of depression after intracerebral hemorrhage in the14th day after onset between the stereotactic group and the conservative group (x2=5.509, P=0.475).5 There were significantly difference between the stereotactic group and the conservative group in the incidence in the 90th day after onset (x2=5.668, P=0.017) and the total incidence of depression after intracerebral hemorrhage during the 3 months after onset (x2=4.416, P=0.036).6 The values of the depression group in the 14th day after onset was (15.00±1.58), which was higher than that of non-depression group (12.15±2.24) (t=2.769, P=0.008); The values of the depression group in the 90th day after onset was (7.41±1.37), which was higher than that of non-depression group (4.69±1.79) (t=5.881, P=0.000).7 In the 14th day and the 90the day after onset, correlation analysis of the NIHSS values and HAMD-17 values respectively were:r=0.549, P=0.000; r=0.663, P=0.000, there were both positive correlation. In the 90the day after onset, correlation analysis of the HAMD-17 values and mRS values respectively were: r=0.665,P=0.000, there was positive correlation between them.Conclusions1 The recovery of the patients with intracerebral hematoma treated with the stereotactic minimal invasive hematoma clearing therapy was better than that of the patients treated with the conservative treatments and the extent of the physical disability was lower, the incidence of depression after intracerebral hemorrhage was also lower in the stereotactic group than that in the conservative group.2 Depression after intracerebral hemorrhage was closely related with the extent of the neurological deficits and the physical disability. The stereotactic minimal invasive hematoma clearing can reduce the incidence of depression after intracerebral hemorrhage through rapidly promoting recovery of neurological function.
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