中風患者鼻胃管的使用對憂鬱傾向及功能預後的影響

The Influence of Nasogastric Tube to Post-Stroke Depressive Tendency and Functional Outcome

黃乃炯(Nai-Chiung Huang) ； 魏大森(Ta-Sen Wei) ； 劉森永(Sen-Yung Liu)

《台灣復健醫學雜誌》 34卷1期 (2006/03) Pp. 19-26

https://doi.org/10.6315/2006.34(1)03

摘要

在中風後的住院階段，有部份的患者發生中風後憂鬱症，並影響患者主動參與復健治療計畫的意願，造成功能恢復緩慢以及功能預後不佳。而使用鼻胃管灌食的患者，通常肢體障礙較嚴重，復健的進展較慢，活動比較不積極。本研究主要是要分析長期使用鼻胃管者與中風後憂鬱傾向的關聯，以及兩者對患者功能預後的影響。共收集了68位患者，記錄了患者的住院和復健天數、中風類型、有無使用鼻胃管、有無留置導尿管等資料，評估項目包括簡短智能狀態檢查(Mini-Mental State Examination)、老年憂鬱量表中譯版(Geriatric Depression Scale)、肢體功能(Brunnstrom's motor recovery stages)、功能獨立量表(Functional Independence Measure, FIM)，並計算復健效率(FIM-efficiency)。
結果發現在單變項分析方面，有憂鬱傾向的患者，簡短智能狀態檢查、功能獨立量表和復健效率明顯較差；使用鼻胃管的患者在肢體功能、簡短智能狀態檢查和功能獨立量表，明顯較差；多變項分析則顯示，鼻胃管的使用與中風後憂鬱有顯著相關。所以臨床上，對於長期使用鼻胃管灌食的患者，應注意觀察有無憂鬱的傾向，並儘早加以積極地治療。

關鍵字

鼻胃管 ； 中風後憂鬱症 ； 功能預後

並列摘要

Depression is reported in a portion of stroke patients during the period of their stay in acute and rehabilitation hospitals. Depression may influence the patient's motivation to participate in the rehabilitation program and result in slower functional recovery and poor functional outcome. In addition, patients with prolonged usage of nasogastric tube for food intake experience a stronger degree of physical impairment, slower functional recovery, and less motivation. The purpose of our study was to determine the correlation between prolonged usage of nasogastric tube and post-stroke patients' depression tendency, and their effects on the patients' functional outcome. Eighty-six patients participated in the study. The study recorded the patient's data, which included days of admission, days of rehabilitation, type of the stroke, usage of nasogastric tube (with or without) and usage of Foley tube (with or without). Evaluated topics included Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Brunnstrom's motor recovery stages (BMRS) and Functional Independence Measure (FIM). FIM efficiency was also calculated.
Looking at the results individually, the study indicated that patients with tendency towards depression are less correlated with MMSE score, FIM score, and FIM efficiency. Patients with prolonged usage of the nasogastric tube have a stronger tendency towards depression and are less correlated with BMRS, MMSE scores, and FIM scores. Looking at the combined results, usage of nasogastric tube is the main risk factor of depression. In conclusion, when facing patients with prolonged usage of nasogastric tube, extra attention is needed to evaluate a patient's tendency towards depression and assess the need to apply a more aggressive treatment.

並列關鍵字

nasogastric tube ； post-stroke depression ； functional outcome