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目的通过观察脑卒中后早期抑郁的血流动力学变化,探讨其临床意义。方法 342例初发前循环急性缺血性脑卒中患者参照中国精神疾病分类方案与诊断标准第三版修订本抑郁症诊断标准,同时采用汉密尔顿抑郁量表17项分为卒中后抑郁组138例和卒中后非抑郁组204例。应用经颅多普勒超声、头颈部计算机断层扫描血管成像、颈部彩色多普勒血流显像检测颅内供血动脉、侧支循环和颈动脉粥样硬化斑块。结果卒中后抑郁组患者有高血压病史、糖尿病病史、脑梗死进展的比例及NIHSS评分均高于卒中后非抑郁组,差异有统计学意义(P均<0.05);卒中后抑郁组额叶/颞叶、丘脑基底节区脑梗死的比例分别高于卒中后非抑郁组,差异有统计学意义(P均<0.05)。卒中后抑郁组病灶侧颈内动脉/大脑中动脉不同程度狭窄发生率、侧支循环建立和颈动脉易损斑块的检出率与卒中后非抑郁组比较差异有统计学意义(P均<0.0.5)。卒中后抑郁组内不同部位梗死之间病灶侧颈内动脉/大脑中动脉不同程度狭窄发生率、侧支循环建立检出率、颈动脉易损斑块检出率比较差异均有统计学意义(P均<0.05)。结论前循环PSD患者存在明显的病灶侧ICA/MCA供血区域血流动力学紊乱,脑梗死病因分型以大动脉粥样硬化型脑梗死为主,病灶侧大脑中动脉中重度狭窄或闭塞为主要责任病变,发病可能以混合机制多见。病灶侧ICA/MCA供血区域血流动力学紊乱可能是前循环急性脑梗死患者早期易发PSD的影响因素之一,是前循环卒中后抑郁的早期筛查和干预目标。
Objective To observe the hemodynamic changes of early post-stroke depression and explore its clinical significance. Methods A total of 342 preeclampsia patients with acute ischemic stroke were enrolled in this study. According to the third edition of China Mental Illness Program and the revised diagnostic criteria for depression, 17 cases were divided into 138 cases of post-stroke depression group 204 cases of post-stroke non-depression group. Transcranial Doppler ultrasound, head and neck computed tomography angiography, and color Doppler flow imaging of the neck were used to detect intracranial feeding artery, collateral circulation and carotid atherosclerosis plaque. Results The post-stroke depression group had a history of hypertension, a history of diabetes mellitus, the progression rate of cerebral infarction and the NIHSS score were higher than those in the post-stroke non-depression group (P <0.05) The proportions of temporal lobe and thalamic basal ganglia infarction were higher than those of post-stroke non-depression group (P <0.05). The prevalence of stenosis, collateral circulation and carotid vulnerable plaque in the Stroke Depression group were significantly different from those in non-depression group after stroke (P < 0.0.5). The prevalence of stenosis, different degrees of stenosis, collateral circulation establishment rate and carotid vulnerable plaque detection rate in different parts of the post-stroke depression group were statistically different (P < P <0.05). Conclusions There is obvious hemodynamic disturbance in the ICA / MCA supplying area in the anterior circulation PSD patients. The main cause of cerebral infarction is mainly atherosclerotic cerebral infarction, and the moderate or severe stenosis or occlusion of the middle cerebral artery in the lesion is the main responsibility Lesions, morbidity may be more common with mixed mechanisms. Hemodynamic disturbances in the ICA / MCA donor area on the lesion side may be one of the influencing factors for PSD in the early stage of AMI and may be the target of early screening and intervention for depression after anterior circulation stroke.