老年慢性阻塞性肺疾病患者的认知功能评价及其相关影响因素分析

发布时间：2018-03-26 02:34

本文选题：慢性阻塞性肺疾病　切入点：老年　出处：《延安大学》2017年硕士论文

【摘要】：目的处于不同分期和分级的老年慢性阻塞性肺疾病(Chronic Obstruction Pulmonary Disease,COPD)患者进行认知状态评估,并对老年COPD认知功能障碍的患者进行相关影响因素分析。方法研究对象为2016年6月至2016年12月在陕西省人民医院老年呼吸科就诊的126例老年COPD患者,根据疾病分期分为急性加重期及稳定期,以FEV1%pred=50%为界再分为轻-中度组及重度组,其中包括32例轻-中度COPD急性加重期组(A1组)、26例重度COPD急性加重期组(A2组)、34例轻-中度COPD稳定期组(S1组)、34例重度COPD稳定期组(S2组)。分别收集四组的年龄、性别、受教育程度、吸烟史、同居者、医保类型、近1年急性加重的次数、病程时间、高血压及心脏病病史、体重指数、血气分析(pH、PaO_2和PaCO_2)、肺功能(FEV1和FVC)、呼出气一氧化氮、电解质(钠钾氯)、简易精神智能评定量表(Mini-mental State Examination,MMSE)、蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评分以及各量表中的多项认知域。采用SPSS18.0数据软件包进行分析。多组资料比较采用单因素方差分析、秩和检验或χ2检验进行分析,再进行组间两两比较差异性;采用多元逐步回归进行分析老年COPD认知功能障碍的相关影响因素,P0.05认为有统计学意义。结果老年COPD患者利用MMSE评估认知受损发病率约54.76%,但采用MoCA量表评估其发病率高达80.15%。MMSE及MoCA评估重度组患者和轻-中度组患者发现,两组间具有统计学意义(P0.01),但各重度组间和各轻-中度组间的认知能力均无统计学意义(P0.05)。利用MoCA评估急性加重期老年患者的认知状态较稳定期更差,但MMSE评估未发现两组间的差异性。老年COPD患者的各认知域进行评估,采用MMSE评价记忆能力,A1组患者强于各重度组患者(P0.05),各轻-中度组患者均好于A2组的患者(P0.05);对COPD稳定期患者而言,各重度组注意力损伤程度亦重于各轻-中度组的患者(P0.05)。MoCA评估S2组患者的注意力明显差于各轻-中度组(P0.01);各重度组患者的延迟回忆明显弱于S1组患者(P0.01);A2组患者的命名能力最差(P0.05)。老年COPD急性加重期患者认知功能障碍的主要影响因素为COPD病程时间和PaCO_2,而稳定期患者主要影响因素有COPD病程时间、医保类型、PaO_2、年龄以及FeNO(P0.05),与PaCO_2相关性不大(P0.05)。其中,A1组患者主要影响因素是受教育程度(r=0.405,P=0.000)和居住类型(r=0.789,P=0.048),S1组患者主要影响因素则是受教育程度(r=0.297,P=0.001)及年龄(r=-0.134,P=0.027);A2组患者主要影响因素是年龄(r=-0.248,P=0.004)和PaCO_2(r=-0.239,P=0.001),S2组患者主要影响因素是病程时间(r=-0.226,P=0.001)。结论1.老年重度COPD患者的认知功能损害明显重于轻-中度患者,急性加重期COPD患者认知受损可能重于稳定期患者,MoCA优越于MMSE。2.随着疾病进展,老年COPD认知功能障碍主要以记忆力和注意力下降为著,命名能力受损可能有助于对重度AECOPD并发认知障碍的快速初筛。3.轻-中度老年COPD患者以自身条件作为主要危险因素影响认知,而重度患者则COPD疾病本身所导致;对于AECOPD患者的认知主要受到PaCO_2影响,而稳定期却以PaO_2为著,与PaCO_2关系不大。
[Abstract]:Aim at different stage and grade of the elderly patients with chronic obstructive pulmonary disease (Chronic Obstruction Pulmonary Disease, COPD) in the evaluation of cognition, and cognitive impairment in the elderly COPD patients for analysis of related factors. Methods from June 2016 to December 2016 in 126 cases of elderly patients with COPD in elderly patients in Department of respiration of Shaanxi People's Hospital, according to disease staging acute exacerbation and stable stage, with FEV1%pred=50% as the boundary is divided into mild to moderate group and severe group, including 32 cases of mild to moderate acute exacerbation of COPD group (A1 group), 26 cases of severe acute exacerbation of COPD group (A2 group), 34 cases of mild to moderate stable COPD group (S1 group), 34 cases of severe stable COPD group (S2 group) were collected. Four groups of age, gender, education level, smoking history, cohabitation, type of medical insurance, the number of nearly 1 years of acute exacerbation of the disease duration, hypertension And a history of heart disease, body mass index, blood gas analysis (pH, PaO_2 and PaCO_2), pulmonary function (FEV1 and FVC), exhaled nitric oxide, electrolyte (Na Jialv), Brief Psychiatric Rating Scale (Mini-mental intelligent State Examination, MMSE), Montreal cognitive assessment (Montreal Cognitive, Assessment, MoCA) and the score the scale of the number of cognitive domain. By using SPSS18.0 software package for data analysis. Many groups of data were compared with single factor variance analysis, rank sum test or 2 test was analyzed, and then compare the differences between groups of 22; by using multiple stepwise regression analysis were used to analyze factors relevant to cognitive dysfunction of elderly patients with COPD, P0.05 was considered statistically results. The elderly patients with COPD by using MMSE to evaluate the cognitive impairment incidence rate is about 54.76%, but the use of MoCA scale to assess the incidence rate of up to 80.15%.MMSE and MoCA in evaluation of severe cases and mild to moderate Patients were found with statistical significance between the two groups (P0.01), but there was no statistically significant between group and severe cognitive ability of all the mild and moderate groups (P0.05). To evaluate the acute exacerbation of cognitive status in elderly patients with stable worse by MoCA, but the MMSE assessment found no differences between the two groups. The cognitive domain of elderly patients with COPD were evaluated by MMSE evaluation of memory ability, A1 group were better than those in the severe group (P0.05), the mild and moderate groups were better than the patients in the A2 group (P0.05); in patients with stable COPD, the severe group attention also heavy damage in the group of patients with mild to moderate.MoCA assessment (P0.05) in S2 group were significantly worse than the attention of mild to moderate group (P0.01); the severe group of patients with delayed recall was significantly weaker than that of S1 group (P0.01); A2 group named the worst (P0.05 years old). Acute exacerbation of COPD the cognitive function in patients with stage The main influence factors for the duration of the COPD barrier and PaCO_2, and the stability of main influencing factors of patients with stage COPD disease duration, type of medical insurance, PaO_2, age and FeNO (P0.05), and PaCO_2 (P0.05) is not relevant. The main influencing factors of A1 patients is the education level (r=0.405, P=0.000) and residential type (r=0.789, P=0.048). The main influencing factors of S1 patients is education level (r=0.297, P=0.001) and age (r=-0.134, P=0.027); the main influence factors of patients in group A2 were age (r=-0.248, P=0.004) and PaCO_2 (r= -0.239 P=0.001). The main influencing factors of S2 patients is the duration (r=-0.226. P=0.001). Conclusion: 1. elderly patients with COPD cognitive impairment was more severe than patients with mild to moderate acute exacerbation of COPD patients, cognitive impairment may in patients with stable, MoCA is superior to MMSE.2. as the disease progresses, the main cognitive dysfunction in elderly COPD To memory and attention to decline, named impairment may contribute to severe cognitive impairment AECOPD with rapid screening of.3. in elderly COPD patients with mild to moderate conditions as major risk factors of cognitive, and patients with severe COPD disease caused by itself; for AECOPD patients cognition mainly affected by PaCO_2, the stable phase at PaO_2, and PaCO_2 little relationship.

【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9

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