Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Cerebrovasc Dis. 2012;33(5):461-5. doi: 10.1159/000336760. Epub 2012 Apr 5.
Many patients with cerebral infarction suffer from symptoms such as pain, fatigue and depression. Most studies focus on single symptoms, but these symptoms often occur together. Whereas symptom clusters have been studied in cancer patients, little is known about different symptom clusters in patients with cerebral infarction. The aim was to evaluate clusters of co-occurring symptoms in the long term. We hypothesized that patients with cerebral infarction display distinct symptom clusters. Furthermore, we hypothesized that multiple co-occurring symptoms have an adverse effect on patients.
All consecutive patients with acute stroke (the index stroke) admitted to the Stroke Unit, Department of Neurology, Haukeland University Hospital, between February 2006 and July 2008, were prospectively registered in a database. Prior risk factors (including diabetes mellitus, hypertension, smoking, coronary heart disease, atrial fibrillation and prior stroke), prior depression and stroke severity (modified Rankin Scale (mRS) score on day 7) were registered. Patients with cerebral infarction were sent a questionnaire including a visual analogue pain scale (VAS), Fatigue Severity Scale (FSS), depression subscale of the Hospital Anxiety, Depression Scale (HADS-D) and Barthel Index at least 6 months after stroke onset.
The questionnaire was returned by 328 patients (response rate 60%). All three symptoms were reported by 10.1%. Pain and fatigue among nondepressed patients were reported by 19.6%. Pain and depression among nonfatigued patients were reported by 2.0%. Depression and fatigue, and no pain were reported by 4.4%. Single symptoms were reported by 31% whereas 33% reported no symptoms. VAS, FSS and HADS-D score severity increased with the number of co-occurring symptoms. Logistic regression analyses showed that two or three symptoms (versus no symptoms) was associated with high mRS score on day 7 (p = 0.02), prior stroke (p = 0.002), prior diabetes mellitus (p = 0.005) and prior depression (p < 0.001).
Symptom clusters are frequent in patients with cerebral infarction. Fatigue was associated with pain and depression whereas there was little association between depression and pain in nonfatigue patients, indicating distinct symptom clusters. The severity of symptoms increased with the number of co-occurring symptoms.
许多脑梗死患者会出现疼痛、疲劳和抑郁等症状。大多数研究都集中在单一症状上，但这些症状通常同时出现。虽然在癌症患者中已经研究了症状群，但对于脑梗死患者的不同症状群知之甚少。本研究旨在评估长期共存的症状群。我们假设脑梗死患者存在不同的症状群。此外，我们还假设多种共发症状会对患者产生不良影响。
2006 年 2 月至 2008 年 7 月期间，连续入组入住挪威卑尔根 Haukeland 大学医院神经内科卒中单元的急性卒中（首发卒中）患者，并前瞻性地将其登记在数据库中。记录既往危险因素（包括糖尿病、高血压、吸烟、冠心病、心房颤动和既往卒中史）、既往抑郁史和卒中严重程度（第 7 天改良 Rankin 量表评分）。在卒中发病后至少 6 个月，向脑梗死患者发送问卷，其中包括视觉模拟疼痛量表（VAS）、疲劳严重程度量表（FSS）、医院焦虑抑郁量表（HADS-D）抑郁分量表和巴氏指数。
共 328 例患者（应答率 60%）返回了问卷。10.1%的患者同时报告了 3 种症状。19.6%的非抑郁患者报告了疼痛和疲劳。2.0%的非疲劳患者报告了疼痛和抑郁。4.4%的患者报告了抑郁和疲劳，且无疼痛。31%的患者报告了单一症状，33%的患者报告无任何症状。VAS、FSS 和 HADS-D 评分严重程度随共发症状数量的增加而增加。Logistic 回归分析显示，与无症状患者相比，2 种或 3 种症状（而非无症状）与第 7 天较高的改良 Rankin 量表评分（p=0.02）、既往卒中（p=0.002）、既往糖尿病（p=0.005）和既往抑郁（p<0.001）相关。
症状群在脑梗死患者中较为常见。疲劳与疼痛和抑郁有关，而在非疲劳患者中，抑郁与疼痛之间的关联较少，提示存在不同的症状群。症状严重程度随共发症状数量的增加而增加。
