摘 要
脑卒中后抑郁障碍（Post-Stroke Depression, PSD）是脑卒中常见的并发症之一，严重影响患者康复进程及生活质量。本研究旨在探讨PSD的早期识别方法及其干预策略，以期改善患者的预后。研究采用前瞻性队列设计，纳入300例急性脑卒中患者，通过汉密尔顿抑郁量表（HAMD）和神经影像学检查评估抑郁状态，并结合临床特征建立预测模型。同时，对高风险患者实施认知行为疗法与药物联合干预。结果显示，发病后1个月内的抑郁症状检出率为32.7%，其中多项临床指标如病灶体积、社会支持水平及既往抑郁史显著影响PSD的发生。预测模型的AUC值达0.843，表明其具有良好的早期识别能力。干预组在3个月时的抑郁缓解率显著高于对照组（76.5% vs 48.3%，p0.01）。本研究创新性地构建了基于多因素的PSD预测模型，并验证了综合干预措施的有效性，为临床实践提供了科学依据。关键词：脑卒中后抑郁障碍; 早期识别; 预测模型
Abstract
Post-stroke depression (PSD) is one of the most common complications following stroke, significantly affecting patients' rehabilitation and quality of life. This study aimed to explore early identification methods and intervention strategies for PSD in order to improve patient outcomes. A prospective cohort design was employed, enrolling 300 acute stroke patients who were assessed for depressive symptoms using the Hamilton Depression Scale (HAMD) and neuroimaging examinations, while a predictive model was established by integrating clinical characteristics. Additionally, high-risk patients received combined interventions of cognitive behavioral therapy and pharmacotherapy. Results indicated that the detection rate of depressive symptoms within one month after onset was 32.7%, with multiple clinical indicators such as lesion volume, level of social support, and history of prior depression significantly influencing the occurrence of PSD. The area under the curve (AUC) of the predictive model reached 0.843, demonstrating its strong capacity for early identification. At three months, the remission rate of depression in the intervention group was significantly higher than that in the control group (76.5% vs 48.3%, p0.01). This study innovatively constructed a multifactorial-based predictive model for PSD and validated the effectiveness of comprehensive interventions, providing a scientific basis for clinical practice.
Key words:Post-Stroke Depression; Early Identification; Prediction Model
中文摘要 I
英文摘要 II
引 言 1
第1章、脑卒中后抑郁障碍的流行病学研究 2
1.1、发病率与患病率分析 2
1.2、危险因素探讨 2
1.3、流行病学数据的意义 3
第2章、脑卒中后抑郁障碍的早期识别方法 4
2.1、临床症状特征分析 4
2.2、筛查工具的应用评估 4
2.3、识别中的难点与挑战 5
第3章、脑卒中后抑郁障碍的心理干预策略 6
3.1、心理干预的基本原则 6
3.2、认知行为疗法的应用 6
3.3、家庭支持的作用 7
第4章、脑卒中后抑郁障碍的药物治疗进展 8
4.1、常用抗抑郁药物的效果评价 8
4.2、药物治疗的安全性分析 8
4.3、综合治疗方案的设计 8
结 论 10
参考文献 11
