T N 

Nh    t trong nhng bnh ph bi   
  vong cao  n t cho ng i ng t sau
i u o.
Nhng xy ra mt ngng n. Nu
  n c     li nhiu di chng. Trong s
nhng ri lon sau nhm cu hin hay
gp. m m 
 u qu ca tc th ti t  n
ri lon chu qu ca phn c
mt bnh nng, nhiu di chi b i
i v i. Trm c xut
hin cp hoc  gn hi phc. u 
a trm cm t m m n nh c m m
n ng thi bnh ca trm c
xen hoc b che lp bi nhng ri loa
t ng vi chn
kinh cao c
y, vic u t c ng a m m sau
i u o p y c n n c m c u u a
m m, p u tr
        c hi ch   nh

Mu:
 a trm cm  bi

u mt s yu t n trm cm  nhng bnh
.
B cc ca lu
Na lum 133 trang vi 27 bng, 3 bi, 16

1.2. RI LON TRM CM
1.2.1. Lch s i trm cm
Su ut ng 
hc thuyt th dch ca Hippocrate (460  377 tr g
 mt dng bn v
gm  su u Melancolicus
m cc ICD 10 p  c sau:
+ F06.32: Trm cm thc tn.
n trm cm trong ri lon CXLC
n trm cm
+ F33: Trm cn
+ F41.2: Ri lon hn h- trm cm
m cm trong ri lon s ng
+ F20.4: Trm ct
1.2.2. Ba trm cm
1.2.2.1. Trm c
1.2.2.2. Trm c        c t  i
lon hoc do s dc c ch n.
1.2.2.3. Trm cm ni sinh:
A. Di truyn
B. Bt thng trong dn truyn th
c tn
i lon trm cm (ICD10)
1.3. M M SAU I U O
1.3.1. Nhu v trm cm sau nh
u t 
m m u h

Hackett Anderson (2005) y ng 


duy c ch, vng c ch hou chn h
ca ICD10 gm 3 triu chng ch yu chng ph bin.
1.3.3.2. Trm c
-  nh bnh c       m cm
n hu hic trng than phin v
u ch, d b t, gim giao ti
nhiu, ng nhi

ng bm cn
nh   u chng ca nhi lon
n thc tn nh , suy gim nhn thc, ri lo
nh ng th bm cm sau nhi
ng ngi cao tui do vy trm cm sau nh 
ng sng vi trm cm ngi cao tui, trm c
m cm c
1.3.4 Mt s yu t n trm cm sau nh
Nhng bi cao tui do
vu t  n th 
ng yu t n s xut hin trm cm  la tui
ng din, suy gim nhn thc, tng kinh t

CH
U

U
t c 

m
243 b
kinh, 44 b            

n n a i u o
n trm cm sau nh ng ch ng 
n n ng t 
u v trm cm sau nh
Mi bm cc tip t t ng
trm cn.
u trm cm sau nhng ph
c 
:
  m chung c   u nh i, gii,
u kin kinh t, ngh nghip, x
m la nh t
 
a trm cm
+ Nh u tr trm cm/nh

a s xut hin trm cu t
a bnh   ti
a nhnh hng ti biu hia trm
cng ca s xut hin trm c
tin trin ca nh
c ti
2.2.3.1. c chun b
 u nh
m cn ca Beck
Bu chi tip vi mu
2.2.3.2. Phn trm cm:
* Bu tr n
 m bo c: mi hi ch
 nh li chu tr.

nh
SD
i
p t
i
cao t
m m
167
64,29
11,775
35
90
m m
76
63,42
10,395
40
86
Chung cho m NC
243
64,02
11,347
35
90
u 35i i p t 
 

u 
+ m i u o u b
nht (78 bm cm  t (25 b

0,8
u c
37
15,2
Trung c c
129
53,1
Trung c 
75
30,9
ng 
243
100
m  nh  c n trung h     t    


ng 3.4: T l trm cm sau i u o


Gii
Nam
N
Tng
P
n=149
%
n=94
%
n=243
%

Bi 3.3:Th ca trm cm
Bng 3.5: c u 

Triu chng
n = 76
T l %
c m
66
86,8
t ch 
50
65,8
ng, t i m t ng.
46
60,5
86,8% c m. t ch , m 65,8%, ng- t
i m t t trong c u 

Bng 3.6 : c m c u 

Triu chng
Tng s
T l % (n = 76)
m 
52
68,4
m t nh 
44
57,9


n n
72
94,7
m n ng
47
61,8
Lo ng, n n
61
80,3
c u 
76
100,0
Suy m n 
4
5,3
n n p 94,7% 
Bng 3.8: 
Triu chng
ng
Tng s
T l % (n = 76)
c m t t, nhanh ng
27
35,5
m n ng t ch c ng i
ng n ra 
34
44,7

30


Di 3.4: c m n n a u 

Khi kh   u ch       
ng 



Di 3.5: c m n n a u 


 Di 3.6: c m n n a u 

u u bi quan, n t

Di 3.7: c m n n a u 
         
u  Di 3.8: c m n n 
30,3% 
c u 


Di 3.9: c m n n a u 
i n c p 100% 

1 ng
Sau
2 ng
Sau
3 ng
Sau
4 ng
Sau
5 ng
Sau
6 ng

i
c

i
c

i
c

i
c

i
c


i


2
0
4

4

4

4

4
m n ng ng
3
1
0
4

4

4

4

4
ng i ng ng

2
1
0
4

6 ng
n=76
%
n=7
6
%
n=76
%
n=76
%
n=76
%
n=7
6
%
n=76
%

TC
10
13,2
15
19,7
15
19,7
19
25,0
36
47,4
49

0,0
0
0,0
TC ng
13
17,1
15
19,7
9
11,8
2
2,6
1
1,3
0
0,0
0
0,0
ng
76
100
76
100
76
100
76
100
76
100
76

Gii s hm cm vi OR = 0,953.
B
n th
n kinh 
m m
ng 
P


Tng
s
T l %
(n = 76)
Tng
s
T l %
(n = 167)
Tng
s
T l %
(n = 243)
Ct
49
64,5
112
67,06
161
66,25
P> 0,05
OR=0,89(0,5-1,58)

n
%
n
%

34
44,7
80
47,9
114
46,9
P=0,65
OR= 0,88(0,51-1,52)

25
32,9
67
40,1
92
37,9
P = 0,28
OR = 0,73 (0,41  1,29)
t
17
22,4
20
12,0
37
15,2
P = 0,04

34
44,7
85
50,9
119
49,0
P0,05
OR=0,78 (0,45-1,35)

42
55,3
82
48,1
124
51,0
i m

1
1,3
2
1,2
3
1,2
P>0,05
OR=1,1(0,1-12,32)

75
98,7
165
98,8


55
82,4
145
86,8
200
82,3
OR=2,52(1,28-4,94)
17,7% s bp, gn mt na s b
 trm cm. vm cm vi OR=2,52

B

u t i 
m m

m m
ng ng
P
n = 76
%
n=167
%
n=243
%
u, p n 
15
19,7
36
21,6

7,8
P=0,004
OR=4,29(1,6-11,4)
n n NMN nh ng
n hy ng
2
2,6
25
15,1
27
11,0
P=0,01
OR=0,15(0,04-0,67)
ng 
76
100
167
100
243
100 Bni vai tra BN khi NMN m m.


Nguy c
m m
m

m m


26
34,2
69
41,3
95
39,1
P = 0,29
OR=0,74(0,42-1,3)
Thay i vai 
i gia nh
10
13,2
10
6,0
20
8,3
P = 0,04
OR=2,37(1,95-6,0)
ng ng
76
100
167
100
243
100

13,2% thay i vai i gia nh, cao n so i 

  trm cm do thay i vai tr a ngi bnh sau nh   i

3,3
8
3,3 >0,05
Bao trong
15
6,2
15
6,2
i 
4
1,6
15
6,2
o 
20
7,9
22
9,0
o
25
10,3
20
8,2
 o
10
4,1
8


P=0,048 OR = 3,287 (1,008 <OR< 10,715)
n th
3.3.2. Trm cng din
ng 3.19: 
m m
t p
ng


m m
48
28
76
m m
83
84
167
ng 
131
112
243

CI 95%
OR = 1,735 (0,995 < OR< 3.025)
m cm sau nhi OR =
1,735
ng 3.20: 
m m
i o ng

i. t 

4.1.2. nh


(bng 3.2). Nam gii b t qu 
h gii, 68% s t qu i. Brown C, Hasson H , V
u 105 b l gi

4.2. C NG A M M SAU I U O
4.2.1. n t m m sau i u o.
 Bp n 
m c

 u bu n
i 1/3 s bu hin trm cm.
Trong           
 

4.2.2. m m .
t 



Brittany Poynter (2009) tng 

 t lun rt
ph bin  c hai gi bin  ph n 
gii.
4.2.3. 


ng 3.6).
 4.2.6. c m c u 
4.2.6.1. c u 
 Qua t 








4.2.6.2. c u 
 Gim tu chng ph bin ca trm cm,
u c 68,7% s bm
cm (b trm cu chi
 3.5).
 t 

 Trong m m m sau i u o y 
68,4%   m p trung .  64,5% nh
  i   ng,  u  m    
ng. t t 

 yi, bn c yu t 
lu t thc ta loi trm cm
sau nhtrong 



 u n c nhanh ng thay n 
hai n n n m m a ICD 10 
c a i nh thay i t ch ng, c ng
u u c. t 

c git ng


 - m n ng t ch c ng
           








            


 - nh ch ch, nh ch thay i m 
 48,7% m m sau i u u
hin nh, nh ch u, n 


 Nh




m cm
 U T 
TRM CM SAU NH

sau NMN.
- Ngay sau i u o, 

n ng ci
u t a trm cm v







17,7% s bp, gn
mt na s b trm cm. S 
thi P= 0,007, vi nguy c trm cp 2,52 ln so vi
 phn ng c-4,94)).
H

u t



Theo Simon (2005), u vai quan n
m m sau i u o. t t n t 

              


   
n
s v  ci trm cm. t t 


m th




4.3.6. MA TRM C N
TH
  l trm cm gi nhu
u cy
trm cm do tn thm cm  
tu ni (46,75% so vi 30,63%), vi CI 95%
nhu t i OR = 1,052 (0,61
 1,81).
 Theo 



u c cn vn  
s a v n thm cm.

 OR = 1,890 (0,558 < OR <6,396

 nh i nguy c CI 95%, OR = 1,236 (0,577 <
OR < 2,649)

v ng OR = 2,655 (1,345
<OR < 5,238).
T N

 t
khi trm ct s kt lun sau:
a trm cm  b
 T l trm cm trong s bi m
78,9% m m n nh, 5,3% u n ng 
t do m m.
 Triu chng khp vi t l 

 u chng  thi k  u ch
bin ca trm c     bin nh  m cm ni
sinh:
 c trm 86,8%, mt m
ng 60,5%
 Gim t tr tin 57,9%, bi
quan v tng b ti 25%
u chm m sau i u
o : c thay i t ch t t (35,5%). m n ng
t ch c ng (44,7%). ch ch, nh n nh
(48,7%)
 c t 

             

 u chng c



hin bnh sm, can thiu tr p thi.
INTRODUCTION

Ischemic stroke is one of the most common diseases and causes of mortality or
disability caused to the survivors after recovering from a ischemic stroke. Worldwide,
the rate of ischemic stroke is approximate1.3% (Bamford, Le Duc Hinh), the number
of new patients is 22/100.000 persons/year. Vietnam is a developing country with the
increasingly-high population of elderly people and the number of people with
ischemic stroke is also increased continuously.
Ischemic stroke usually occurs suddenly and heavily with focal neurological
symptoms, disorders of consciousness and is the cause resulting in high mortality rate.
If the patient can recover after the acute episode, it is usually resulted in many
physical, mental sequelae and the lower quality of life as well as the working ability
of the patients. Among the mental disorders after ischemic stroke, depression is one of
the common manifestations. The rate of depression is commonly occurred to one third
of people after ischemic stroke. This is not only a result of brain injury and
dysfunction, but also as a result of psychological responses again a serious illness,
many squeals, and patients are at risk of having the personnel position changed in
their job, family and society. Depression can occur even in the acute stage or in the
recovery episode. The clinical symptoms of depression may be a major depression or
minor depression, and clinical symptoms of the depression are overlapped or obscured
by the mental disorder with the anonymous damage to brain function area. According
to Linda's. William (2004), if depression after ischemic stroke is not detected and
treated promptly, it will not only affect the ability to restore function and quality of
work and quality of life but also increase the risk of death for these patients [3].
Therefore, understanding the clinical symptoms of the depression ischemic
stroke will help the doctors to identify early signs of depression, help the patients to
have early interventions to be treated properly and promptly. It has important meaning
in care and rehabilitation for the patients after suffering from a ischemic stroke.
1. Objectives of the study