本文選題：慢性阻塞性肺疾病　切入點(diǎn)：老年　出處：《延安大學(xué)》2017年碩士論文

【摘要】：目的處于不同分期和分級(jí)的老年慢性阻塞性肺疾病(Chronic Obstruction Pulmonary Disease,COPD)患者進(jìn)行認(rèn)知狀態(tài)評(píng)估,并對(duì)老年COPD認(rèn)知功能障礙的患者進(jìn)行相關(guān)影響因素分析。方法研究對(duì)象為2016年6月至2016年12月在陜西省人民醫(yī)院老年呼吸科就診的126例老年COPD患者,根據(jù)疾病分期分為急性加重期及穩(wěn)定期,以FEV1%pred=50%為界再分為輕-中度組及重度組,其中包括32例輕-中度COPD急性加重期組(A1組)、26例重度COPD急性加重期組(A2組)、34例輕-中度COPD穩(wěn)定期組(S1組)、34例重度COPD穩(wěn)定期組(S2組)。分別收集四組的年齡、性別、受教育程度、吸煙史、同居者、醫(yī)保類型、近1年急性加重的次數(shù)、病程時(shí)間、高血壓及心臟病病史、體重指數(shù)、血?dú)夥治?pH、PaO_2和PaCO_2)、肺功能(FEV1和FVC)、呼出氣一氧化氮、電解質(zhì)(鈉鉀氯)、簡(jiǎn)易精神智能評(píng)定量表(Mini-mental State Examination,MMSE)、蒙特利爾認(rèn)知評(píng)估量表(Montreal Cognitive Assessment,MoCA)評(píng)分以及各量表中的多項(xiàng)認(rèn)知域。采用SPSS18.0數(shù)據(jù)軟件包進(jìn)行分析。多組資料比較采用單因素方差分析、秩和檢驗(yàn)或χ2檢驗(yàn)進(jìn)行分析,再進(jìn)行組間兩兩比較差異性;采用多元逐步回歸進(jìn)行分析老年COPD認(rèn)知功能障礙的相關(guān)影響因素,P0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。結(jié)果老年COPD患者利用MMSE評(píng)估認(rèn)知受損發(fā)病率約54.76%,但采用MoCA量表評(píng)估其發(fā)病率高達(dá)80.15%。MMSE及MoCA評(píng)估重度組患者和輕-中度組患者發(fā)現(xiàn),兩組間具有統(tǒng)計(jì)學(xué)意義(P0.01),但各重度組間和各輕-中度組間的認(rèn)知能力均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。利用MoCA評(píng)估急性加重期老年患者的認(rèn)知狀態(tài)較穩(wěn)定期更差,但MMSE評(píng)估未發(fā)現(xiàn)兩組間的差異性。老年COPD患者的各認(rèn)知域進(jìn)行評(píng)估,采用MMSE評(píng)價(jià)記憶能力,A1組患者強(qiáng)于各重度組患者(P0.05),各輕-中度組患者均好于A2組的患者(P0.05);對(duì)COPD穩(wěn)定期患者而言,各重度組注意力損傷程度亦重于各輕-中度組的患者(P0.05)。MoCA評(píng)估S2組患者的注意力明顯差于各輕-中度組(P0.01);各重度組患者的延遲回憶明顯弱于S1組患者(P0.01);A2組患者的命名能力最差(P0.05)。老年COPD急性加重期患者認(rèn)知功能障礙的主要影響因素為COPD病程時(shí)間和PaCO_2,而穩(wěn)定期患者主要影響因素有COPD病程時(shí)間、醫(yī)保類型、PaO_2、年齡以及FeNO(P0.05),與PaCO_2相關(guān)性不大(P0.05)。其中,A1組患者主要影響因素是受教育程度(r=0.405,P=0.000)和居住類型(r=0.789,P=0.048),S1組患者主要影響因素則是受教育程度(r=0.297,P=0.001)及年齡(r=-0.134,P=0.027);A2組患者主要影響因素是年齡(r=-0.248,P=0.004)和PaCO_2(r=-0.239,P=0.001),S2組患者主要影響因素是病程時(shí)間(r=-0.226,P=0.001)。結(jié)論1.老年重度COPD患者的認(rèn)知功能損害明顯重于輕-中度患者,急性加重期COPD患者認(rèn)知受損可能重于穩(wěn)定期患者,MoCA優(yōu)越于MMSE。2.隨著疾病進(jìn)展,老年COPD認(rèn)知功能障礙主要以記憶力和注意力下降為著,命名能力受損可能有助于對(duì)重度AECOPD并發(fā)認(rèn)知障礙的快速初篩。3.輕-中度老年COPD患者以自身?xiàng)l件作為主要危險(xiǎn)因素影響認(rèn)知,而重度患者則COPD疾病本身所導(dǎo)致;對(duì)于AECOPD患者的認(rèn)知主要受到PaCO_2影響,而穩(wěn)定期卻以PaO_2為著,與PaCO_2關(guān)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.

【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.9

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