徐帅　　张菁　　张翠平

[摘要] 目的 探讨强化平衡训练联合心理治疗在中青年卒中后抑郁患者平衡功能中的应用效果。方法 选取我院2018年6月至2020年5月康复科PSD患者84例为研究对象。按随机数字表将患者分为观察组和对照组，每组各42例。对照组采用抗抑郁药治疗和常规平衡训练，观察组在对照组基础上实施心理治疗后再进行强化平衡训练，以比较两组患者抑郁状况、平衡功能和下肢功能。 结果 两组患者治疗前HAMD评分比较，差异无统计学意义（P>0.05），治療后两组评分均出现不同程度下降（P<0.05），且观察组评分明显低于对照组（t=6.835，P<0.05）;治疗后观察组BBA各维度评分显著高于对照组 P<0.05）;两组患者FMA 评分较治疗前明显上升（P

[关键词] 强化平衡训练;心理治疗;中青年;卒中后抑郁;平衡功能;下肢功能

[中图分类号] R743.33          [文献标识码] A          [文章编号] 1673-9701（2021）13-0025-04

Application of intensive balance training combined with psychotherapy in the balance function of young and middle-aged patients with post-stroke depression

XU Shuai   ZHANG Jing   ZHANG Cuiping

Department of Rehabilitation， Zaozhuang Mining Group Central Hospital， Zaozhuang   277800， China

[Abstract] Objective To explore the application effect of intensive balance training combined with psychotherapy in the balance function of young and middle-aged patients with post-stroke depression. Methods A total of 84 patients with PSD in the rehabilitation department from June 2018 to May 2020 in our hospital were selected as the research objects. According to the random number table， the patients were divided into the observation group and the control group， with 42 cases in each group. The control group was treated with antidepressants and conventional balance training， and the observation group was treated with intensive balance training based on the treatment of the control group before psychotherapy. The depression status， balance function， and lower limb function of the two groups were compared. Results There was no significant difference in HAMD scores between the two groups before treatment（P>0.05）. After treatment， the scores of the two groups decreased to varying degrees（P<0.05）， and the scores of the observation group were significantly lower than those of the control group（t=6.835， P<0.05）. After treatment， the scores of all dimensions of BBA in the observation group were significantly higher than those of the control group（P<0.05）. The FMA scores of the two groups were significantly higher than before treatment（P<0.05）， and the increase in the observation group was more significant than that of the control group（t=2.336， P<0.05）. Conclusion Intensive balance training combined with psychotherapy can improve the depression of young and middle-aged patients after stroke， prompt the patients to strictly follow the intensive balance training formulated by the therapist， thereby improving the patient's balance function and lower limb mobility.

[Key words] Intensive balance training; Psychotherapy; Young and middle-aged; Post-stroke depression; Balance function; Lower limb function

我国40岁以上的脑卒中患者中，中年约占57%[1]，脑卒中发病年轻化趋势非常明显，已严重威胁中青年人群身心健康。张莹等[3]研究显示，患者卒中后抑郁（Post-stroke depression，PSD）的发生率高达38.6%，主要表现为淡漠、兴趣下降、思维迟缓，甚至出现无价值感、绝望及自杀等症状[2]，这与中年患者承上启下的社会属性有关，来自社会、家庭及经济各方面的压力，一旦患者丧失了社会劳动能力，自责感、焦虑等抑郁表现更明显[4]，导致患者康复锻炼依从性差，甚至拒绝康复治疗。无论是对患者的功能恢复、生活质量的提高还是对减轻家庭和社会的负担，中青年PSD的平衡及步行功能的恢复对于患者的功能独立意义重大。本研究将心理治疗联合强化平衡训练运用到中青年PSD患者中取得较好效果，现报道如下。