老年高血压患者围术期个体注意网络受损的研究

发布时间：2018-02-22 21:34

本文关键词： 高血压注意网络认知障碍老年患者 MoCA 量表　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的高血压是老年人常见的心血管病,发病率逐年增长。高血压与认知功能的关系也逐渐引起重视,高血压患者围术期认知功能的改变情况以及机制目前尚不清楚。注意组成认知功能的重要部分,有认知功能障碍的患者往往都并存有注意网络的损害。Fan利用注意网络试验测试(Attention network test,ANT)对注意网络系统进行相关研究,ANT有明确的神经解剖定位和递质,故利用ANT对老年人围术期注意网络进行研究有助于揭示围术期认知功能改变的机制。本研究主要利用ANT测试探讨老年高血压患者围术期个体注意网络改变的特点。方法实验一:利用蒙特利尔认知量表(Mo CA)评估老年高血压患者的认知功能。选取有3~5年Ⅰ期未治疗的自发性高血压病史患者30例,正常血压组30例,两组在性别、年龄、受教育程度以及MMSE评分等方面均无统计学差异。运用注意网络测试(ANT)评估3个注意网络(警觉、定向、执行控制)的效率。实验二:我院择期行单侧关节置换(髋关节或者膝关节)且不存在术前认知功能障碍的60岁以上老年患者25例。手术组在术前完成MMSE量表评分以及ANT测试,术后第2d及第7d再次进行ANT测试,观察被试者围术期警觉、定向和执行控制3个注意网络效率的变化。同时选择25例年龄、受教育程度相匹配的老年人作为对照组,完成MMSE量表评分,在与手术组间隔相同的三个时间点进行ANT测试以排除学习效应。实验三:选择20名未治疗Ⅰ期老年高血压患者,以及20名年龄、性别以及受教育程度相匹配的60岁以上老年患者作为对照组,两组均行择期单侧关节(髋关节或膝关节)置换手术。所有参与者术前均完成MMSE量表评分,分别在术前和术后第7d完成ANT测试。统计学处理:采用SPSS 13.0软件进行统计学处理,P0.05认为差异有统计学意义。结果实验一:高血压组与正常血压组相比,Mo CA视空间执行能力、注意力、延迟回忆和总得分均明显降低,差异有统计学意义(P0.05)。高血压患者注意网络出现明显损害,特别是在警觉和执行控制网络方面。实验二:手术组围术期平均反应时、正确率无明显改变,术后第2d警觉(P=0.004)和执行控制(P=0.035)网络效率明显受损,但是术后第7d恢复到术前水平(P=0.349,P=0.342),定向网络效率在术后第2d明显受损(P0.001)。与术前相比,术后第7d定向网络效率仅部分恢复(P0.001)。对照组三个注意网络效率、平均反应时以及正确率在三个不同的时间点结果比较均无明显统计学差异。实验三:高血压组术后第7d警觉(P=0.007)、定向(P0.001)以及执行控制(P=0.005)网络效率与术前相比明显受损。对照组术后第7d警觉(P=0.113)、执行控制(P=0.404)网络效率与术前相比无明显统计学差异,定向网络效率未恢复(P0.001)。两组的术前正确率与术后第7d相比均无统计学差异。结论实验一:未治疗的Ⅰ期老年高血压患者Mo CA视空间执行能力、注意力、延迟回忆和总得分均明显降低,提示高血压患者存在认知功能损害。高血压患者注意网络出现明显损害,特别是在警觉和执行控制网络方面。实验二:老年患者围术期注意网络出现明显损害。术后第2d老年患者空间记忆执行能力明显受损,然而术后第7d定向能力未完全恢复,警觉和执行控制网络效率比定向网络效率提前恢复。实验三:老年人长期高血压导致注意网络受损,这种损害在术后加重特别是在警觉和执行控制网络方面。
[Abstract]:Objective hypertension is the cardiovascular diseases of the elderly, the incidence increased year by year. The relationship between hypertension and cognitive function also gradually pay attention to perioperative cognitive function in patients with hypertension and changes of the mechanism is unclear. An important part of the cognitive function of patients with cognitive dysfunction and often have attention network damage using.Fan test (Attention network network test, ANT) to research on the attention network system, ANT has a clear positioning and anatomy of neural transmitters, so using ANT to pay attention to network elderly perioperative research helps to reveal the mechanism of perioperative cognitive changes. This research mainly uses the ANT test to investigate elderly patients with hypertension in perioperative period of individual attention networks change. Methods: using Montreal cognitive scale (Mo CA) high blood pressure risk assessment of elderly The cognitive function of the selected 3~5. Phase I of untreated spontaneous hypertension in 30 cases, 30 cases of normal blood pressure group, the two groups in gender, age, there was no significant difference in terms of education level and MMSE score. The attention network test (ANT) to evaluate 3 attention network (alert, directional the execution, control) efficiency. Experiment two: our hospital undergoing unilateral knee replacement (hip or knee) and 25 elderly patients over the age of 60 preoperative cognitive dysfunction patients. The control group underwent MMSE score and ANT test in preoperative, postoperative 2D and 7d again ANT test the observation, the subjects of perioperative vigilance, orienting and executive attention of 3 network efficiency changes. While 25 cases age, education matched elderly as control group, MMSE score at three time points with the same interval and operation group For the ANT test to exclude the learning effect. Experiment three: 20 untreated stage I in elderly hypertensive patients, and 20 age, sex and education matched over the age of 60 elderly patients as the control group, two groups of patients undergoing unilateral knee (hip or knee replacement surgery). All participants were before the completion of the MMSE scale score, respectively before and after operation in 7d ANT test. Statistical analysis: statistical analysis using SPSS 13 software, P0.05 considered statistically significant. Results: hypertension group compared with the normal blood pressure group, Mo CA visuospatial ability, attention, delayed recall and total the scores were significantly decreased, the difference was statistically significant (P0.05). Patients with hypertension attention network obvious damage, especially in terms of the alerting and executive control network. Experiment two: operation group during the perioperative period of average response time, correct rate No significant change after the 2D alert (P=0.004) and executive control (P=0.035) network efficiency is impaired, but after the 7d returned to preoperative levels (P=0.349, P=0.342), directed network efficiency in 2D after operation was significantly impaired (P0.001). Compared with the preoperative, only partially restored 7d orientation the efficiency of the network after the operation (P0.001). The control group three note network efficiency, the average response time and accuracy rate at three different time points of the results showed no significant statistical difference. Experiment three: hypertension group 7d after operation (P=0.007), directional alert (P0.001) and control (P=0.005) and network efficiency compared to the preoperative control group was significantly impaired. After the 7d alert (P=0.113) (P=0.404), executive control network efficiency compared with the preoperative no statistically significant difference, directional network efficiency is not restored (P0.001). The two group of preoperative accuracy compared with postoperative 7d were not statistically significant. Conclusion Experiment 1: untreated stage Mo CA in elderly hypertensive patients with visuospatial ability, attention, delayed recall and total scores were significantly decreased, suggesting that hypertensive patients have cognitive impairment in patients with hypertension. The attention network obvious damage, especially in terms of the alerting and executive control network. Experiment two: pay attention to network appear obvious damage in elderly patients patients in the perioperative period. Postoperative memory in elderly patients with 2D spatial executive ability was significantly impaired, but after the 7d directional ability is not fully recovered, the alerting and executive control network efficiency than directional network efficiency in advance recovery. Experiment three: the elderly long-term hypertension leads to impaired attentional network, the damage after operation increased especially in the in terms of the alerting and executive control network.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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