急性脑梗死伴高血压患者程序性降压后认知结局及影响因素研究

发布时间：2018-02-26 11:43

本文关键词： 卒中后认知功能障碍脑梗死高血压尿酸同型半胱氨酸 C-反应蛋白脉压程序性降压 MMSE MoCA　出处：《泰山医学院》2014年硕士论文　论文类型：学位论文

【摘要】：研究目的 1.通过对急性脑梗死伴高血压患者进行程序性降压，研究程序性降压对卒中后认知功能的影响。 2.研究急性脑梗死伴高血压患者程序性降压后认知功能改变的相关影响因素。研究方法 1.收集自2011年9月至2013年3月期间在中国人民解放军第八十八医院住院的急性脑梗死伴高血压病患者204例，随机分为实验组及对照组，实验组予以程序性降压治疗，对照组不予以降压治疗，收集患者入院时基线资料并采用上海北辰软件有限公司的认知功能检测仪进行MMSE、MoCA、HIS、HAMD量表检测，于患者发病后3个月、12个月进行随访，复测患者认知功能及神经功能，比较两组认知功能差异。 2.随访3月、12月，研究急性脑梗死伴高血压患者发生卒中后认知功能障碍的危险因素，并研究尿酸、同型半胱氨酸、C-反应蛋白及脉压在程序性降压后卒中后认知功能障碍患者中发挥作用。结果 1.基线时实验组及对照组的MMSE及MoCA评分无明显差异（P0.05），3月时对照组MMSE及MoCA评分分别为（22.23±4.52）、（19.41±4.62），实验组为（24.90±3.58）、（22.39±4.08），对照组认知功能评分低于实验组（P0.05）。12月时对照组MMSE及MoCA评分分别为（20.74±4.57）、（18.23±5.10），实验组为（25.44±3.79）、（22.31±4.29），对照组认知功能评分低于实验组（P0.05）。 2.3月时对照组卒中后认知功能障碍的发病率为35.0%，，实验组为19.2%，对照组发病率高于实验组（P0.05）。12月时对照组卒中后认知功能障碍的发病率为55.0%，实验组为28.8%，对照组高于实验组（P0.05）。 3.卒中后认知功能障碍组与认知功能正常组间性别构成比、房颤、高脂血症无差异（P0.05）；两组间年龄、受教育年限、糖尿病、脉压、程序性降压、尿酸、同型半胱氨酸、C-反应蛋白存在差异（P0.05），将有差异的危险因素引入非条件多因素Logistic回归模型分析后，糖尿病被剔除，程序性降压、高受教育年限为保护性因素，年龄、脉压、尿酸、同型半胱氨酸、C-反应蛋白为危险因素。 4.随访程序性降压组患者至3月、12月，入院时高尿酸血症组认知功能评分优于非高尿酸血症组（P0.05）；高同型半胱氨酸血症组认知功能评分低于同型半胱氨酸正常组（P0.05）；C-反应蛋白增高组认知功能评分低于C-反应蛋白正常组（P0.05）；脉压增高组认知功能评分低于非脉压增高组（P0.05）。研究结论 1.程序性降压可能会改善急性期脑梗死伴高血压患者3月、12月的认知结局，降低3月、12月时卒中后认知功能障碍的发生率。 2.年龄、尿酸、同型半胱氨酸、C-反应蛋白及脉压为急性期脑梗死伴高血压患者发生卒中后血管性认知功障碍的危险因素，程序降压、高受教育年限为保护性因素。 3.尿酸、同型半胱氨酸、C-反应蛋白及脉压与程序性降压后急性脑梗死伴高血压患者的认知功能呈负相关。研究意义该实验研究了程序性降压对认知功能结局的影响，并对认知功能障碍有关危险因素进行了系统研究，提供了大量的真实、详尽的临床资料，为急性期脑梗死患者程序性降压安全性进一步提供了证据。
[Abstract]:research objective
1. by program hypotension on acute cerebral infarction patients with hypertension, effects of procedural hypotension on cognitive function after stroke.
Related factors of cognitive function changes in 2. of acute cerebral infarction patients with hypertension hypotension after the procedure.
research method
204 patients with hypertension were collected from September 2011 to March 2013 with 1. during acute cerebral infarction hospitalized in No.88 Hospital of PLA, were randomly divided into experimental group and control group, experimental group received procedural antihypertensive therapy, the control was not treated with antihypertensive therapy, patients were collected baseline data and using the cognitive function detector of Shanghai Software Co. Ltd. of Beichen MMSE, MoCA, HIS, HAMD scale test in patients after 3 months follow-up of 12 months, retest the cognitive function of patients with neurological function and cognitive function, the difference between the two groups.
2. follow up on March, December, the research of acute cerebral infarction and risk factor for cognitive impairment in patients with hypertension after stroke, and uric acid, homocysteine, C-reactive protein C- and pulse pressure on procedural hypotension after stroke in patients with cognitive impairment after play a role.
Result
1. baseline MMSE and MoCA experimental group and control group, there were no significant differences (P0.05) in March, when the control group MMSE and MoCA scores were (22.23 + 4.52), (19.41 + 4.62), experimental group (24.90 + 3.58), (22.39 + 4.08), the control group were lower than those of experimental cognitive function group (P0.05).12 months control group MMSE and MoCA scores were (20.74 + 4.57), (18.23 + 5.10), experimental group (25.44 + 3.79), (22.31 + 4.29), the control group cognitive function score was lower than that of the experimental group (P0.05).
The control group at 2.3 months after stroke onset of cognitive impairment was 35%, 19.2% in the experimental group and the control group the incidence rate is higher than the experimental group (P0.05).12 months control group after stroke onset of cognitive impairment was 55%, 28.8% in the experimental group, the control group was higher than that of the experimental group (P0.05).
3. post-stroke cognitive dysfunction group and cognitive function between normal group sex ratio, atrial fibrillation, no difference in hyperlipidemia (P0.05); two groups of age, years of education, diabetes, pulse pressure, procedural hypotension, uric acid, homocysteine, C-reactive protein between C- (P0.05), there will be risk factors the difference of the multi factor non conditional Logistic regression model analysis, diabetes were excluded, procedural hypotension, education for high protective factors, age, blood pressure, uric acid, homocysteine, C-reactive protein C- as risk factors.
In December 4. follow-up program hypotension patients to March, admission of hyperuricemia group cognitive function scores than non hyperuricemia group (P0.05); hyperhomocysteinemia group cognitive function score was lower than that of normal homocysteine group (P0.05); C- reactive protein group increased cognitive function score was lower than the normal group C- reactive protein (P0.05); the ASI group cognitive function score lower than the ASI group (P0.05).
research conclusion
1. program hypotension may improve the acute cerebral infarction with hypertension in March, December March to reduce cognitive outcomes, in December, the incidence of cognitive impairment after stroke.
2. age, uric acid, homocysteine, risk factors, C- reactive protein and pulse pressure in patients with acute cerebral infarction with hypertension after stroke in patients with vascular cognitive dysfunction of the high education program buck, as a protective factor.
3. uric acid, homocysteine, C-reactive protein C- and pulse pressure and hypotension after acute cerebral infarction with program of cognitive function in patients with hypertension was negatively correlated.
research meaning
The experimental study on the effect of hypotension on cognitive function of program outcomes, and the risk factors of cognitive dysfunction were studied, providing a large number of real and detailed clinical data, procedures for acute hypotension in patients with cerebral infarction safety provides further evidence.

【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3;R544.1

【参考文献】