单病灶脑出血患者认知功能的LOTCA量表评定研究

发布时间：2018-03-12 19:45

本文选题：脑出血　切入点：认知障碍　出处：《昆明医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的探讨用LOTCA量表评定单病灶脑出血患者早期认知功能障碍的特点及认知障碍与焦虑、抑郁之间的相关性,并探讨影响认知障碍的相关因素。方法依据设定的脑出血病例组与健康对照组纳入和排除标准,选取2013年03月至2014年02月在昆明医科大学第一附属医院神经内科诊疗的脑出血患者48例为脑出血病例组,以与病例组年龄、性别、教育程度相匹配的患者家属、陪护人员、医务人员等健康人群50名为健康对照组,评定时间为发病后半个月之内。应用洛文斯顿作业疗法认知评定中文量表(Loewenstein Occupational Therapy Cognitive Assessment Second Edition, LOTCA)(第二版)从定向、知觉、动作运用、视运动组织、思维操作、注意力等方面评估研究对象的认知情况；两组比较是否有差异。按照年龄、受教育程度、各相关因素等将脑出血病例组进行分组评估,分析这些因素与量表得分之间的相关性。Zung氏抑郁自评量表(SDS)和Zung氏焦虑自评量表(SAS)评定其是否有抑郁焦虑状态。结果1.脑出血病例组与健康对照组认知功能结果比较：认知功能LOTCA总得分、各子项目及各次级子项目得分,脑出血病例组得分均较低,差异有统计学意义(P0.05)；2.脑出血患者认知功能LOTCA得分与SDS、SAS等级评分三者间相关分析：①认知功能LOTCA总得分与SDS、SAS等级评分有相关性(r=0.320, r=0.481, P＜0.05);②其中定向力、视知觉、空间知觉、动作运用、视运动组织和思维操作的LOTCA得分与SDS、SAS等级评分相关性的r值范围分别为0.190至0.390、0.110至0.481。3.脑出血后有抑郁、焦虑的患者认知功能LOTCA总得分较脑出血后非抑郁焦虑状态的患者得分低,两者差异有统计学意义(P0.05)。4.老年、吸烟、饮酒、高血压、血糖异常、血脂异常、发病时血肿大、破入脑室的脑出血患者认知功能LOTCA得分较对照组得分低(P0.05),性别、不同侧脑出血患者的认知功能LOTCA得分比较(P0.05),但进一步行多重回归分析示患者住院时谵妄或烦躁、年龄大、低教育水平、高血压、不同侧脑出血的P值均很小(P0.05),说明进入方程的5个因素都有作用。结论1.单病灶脑出血患者存在一定程度的早期认知功能障碍,出现定向、视知觉、空间知觉、动作运用、视运动组织、思维操作认知功能的广泛损害。2.抑郁、焦虑影响脑出血患者早期认知功能。3.患者住院时谵妄或烦躁、年龄大、低教育水平、高血压、不同侧脑出血可能对脑出血患者认知障碍的发生影响较大。
[Abstract]:Objective to investigate the characteristics of early cognitive dysfunction in patients with single focus intracerebral hemorrhage (ICH) and the correlation between cognitive impairment and anxiety and depression with LOTCA scale, and to explore the related factors affecting cognitive impairment. Methods according to the established criteria of intracerebral hemorrhage (ICH) and healthy control group, 48 ICH patients from March 2013 to February 2014 in the Department of Neurology, first affiliated Hospital of Kunming Medical University, were selected as ICH group. A total of 50 healthy people, such as family members, accompanying staff and medical staff, who matched the age, sex and education level of the case group, were taken as the healthy control group. Using Loewenstein Occupational Therapy Cognitive Assessment Second Edition, LOTCAA (second edition), from orientation, perception, action use, visual and motor organization, thinking operation, Loewenstein Occupational Therapy Cognitive Assessment Second Edition, was evaluated within half a month after the onset of the disease. The cognitive status of the subjects was evaluated from the aspects of attention, and whether there were differences between the two groups. According to the age, the education level and the relevant factors, the patients with ICH were assessed in groups. Analysis of the correlation between these factors and the score of the scale. Zung's Self-Rating Depression scale (SDS) and Zung's Self-Rating anxiety scale (Zung) were used to evaluate their depression and anxiety status. Results 1. The results of cognitive function in ICH group and healthy control group were as follows: the total score of cognitive function LOTCA, the scores of subitems and sub-items, and the scores of ICH patients were lower. 2. Correlation between LOTCA score of Cognitive function and LOTCA score of Cognitive function in patients with intracerebral Hemorrhage; correlation between the total score of LOTCA of cognitive function and the score of SDS-1 SAS grade: r = 0.320, r = 0.481, P < 0.05 / 2, in which orientation, visual perception, spatial perception, movement use, and so on. The r range of the correlation between the LOTCA score of visual motor organization and thinking operation and the score of SDSs was 0.190 to 0.390 ~ 0.110 to 0.481.3 respectively. The total score of cognitive function LOTCA in patients with depression after ICH was lower than that in patients with non-depressive anxiety after ICH. The difference was statistically significant (P 0.05). The scores of cognitive function LOTCA of the patients with intracerebral hemorrhage were lower than those of the control group (P 0.05), and the scores of cognitive function of the patients with cerebral hemorrhage were lower than those of the control group (P 0.05), and the scores of the patients with cerebral hemorrhage were lower than those of the control group (P 0.05). The LOTCA scores of cognitive function in patients with different cerebral hemorrhage were compared (P 0.05), but further multiple regression analysis showed that the patients had delirium or irritability, age, low education level and hypertension. The P values of different cerebral hemorrhage were all very small, indicating that the five factors involved in the equation were all effective. Conclusion 1. The patients with single focus intracerebral hemorrhage have some early cognitive dysfunction, such as orientation, visual perception, spatial perception, movement use, visual motor organization, thinking operation and cognitive function. 2. Depression. Anxiety affects early cognitive function of patients with intracerebral hemorrhage .3.The patients with inpatient delirium or irritability, age, low education level, hypertension, different side cerebral hemorrhage may have a greater impact on the occurrence of cognitive disorders in patients with cerebral hemorrhage.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34

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