【摘要】：背景與目的：維持性血液透析患者更易發(fā)生認知功能損害,嚴重的認知功能損害與血液透析患者的高死亡率、終止透析,住院率,致殘等不良預(yù)后密切相關(guān)。同時,我可們可以通過認知功能水平評估患者的腦功能狀態(tài),及時發(fā)現(xiàn)問題。認知功能損害增加了患者的死亡風(fēng)險。國內(nèi)目前對于維持性血液透析患者認知功能狀態(tài)的研究開展較少。本研究旨在初步調(diào)查維持性血液透析人群的認知功能狀態(tài)并探討其相關(guān)危險因素。 對象與方法：本研究為橫斷面調(diào)查研究。于2012年1月-2012年3月間對在河北醫(yī)科大學(xué)第三醫(yī)院行維持性血液透析治療患者71例,其中原發(fā)病疾病為慢性腎小球腎炎28例(39.4%),糖尿病腎病11例(15.5%),高血壓腎損害9例(12.7%)；年齡在22～83歲之間,平均53.1±15.8歲；其中男性37例(52.1%),女性34例(47.9%)；透析時間在4～140月之間,平均透析時間在4～140月之間,平均39.7±29.6月月。 記錄71例參與者性別、年齡、透析齡、原發(fā)病、既往病史等個人信息,并連續(xù)記錄10次透析前血壓、透析過程中血壓變化。神經(jīng)心理學(xué)測試部分采用蒙特利爾量表中文版評估其認知功能(受教育年限小于12年者加1分,總分26分認為存在認知功能損害),由同一調(diào)查員依據(jù)標準指導(dǎo)語,對受試對象進行神經(jīng)心理學(xué)量表測試,準確記錄結(jié)果。所有量表完成時間均為患者接受透析治療前。實驗室檢查部分血樣采集時間均為患者行血液透析治療前。影像學(xué)檢查部分患者行側(cè)位腹平片檢查,觀察腹主動脈鈣化情況,由影像科醫(yī)師按照國外評分標準進行血管鈣化評分。 結(jié)果：71例患者全部完成了量表,平均得分為22.9±4.3,其中45例量表得分小于26分,26例得分大于(含)26分,故本研究認知功能損害發(fā)生情況為63.4%。將患者分為認知功能損害組與無認知功能損害組,首先進行單因素分析,兩組間,參與者年齡構(gòu)成、受教育時間、透析過程中最低舒張壓、原發(fā)病中糖尿病腎病比例存在明顯差異,P均小于0.05,有統(tǒng)計學(xué)意義；性別構(gòu)成、血清白蛋白水平存在差異,但0.05P0.10,結(jié)果趨于有統(tǒng)計學(xué)意義。而兩組間透析齡、腹主動脈鈣化水平、血紅蛋白水平、透析前血壓水平、透析過程中血壓變化幅度、腦血管意外病史、體重指數(shù)等因素的差異,P0.10,無統(tǒng)計學(xué)意義。然后將有或趨于有統(tǒng)計學(xué)意義的影響因素進行多重逐步回歸分析,最終女性(OR=3.542,P0.05)和低文化水平(OR=-O.803,P0.05)被確定為認知損害的獨立危險因素。 結(jié)論：在維持性血液透析患者中,認知功能損害普遍存在,女性較男性更易發(fā)生認知功能損害,且受教育時間越短,發(fā)生認知功能損害的可能越大。
[Abstract]:Background & objective: maintenance hemodialysis patients are more prone to cognitive impairment. The severe cognitive impairment is closely related to the high mortality rate, termination of dialysis, hospitalization rate, disability and other adverse prognosis of hemodialysis patients. At the same time, we can assess the cognitive function of patients with brain function state, timely detection of problems. Cognitive impairment increases the risk of death. There are few studies on cognitive function of maintenance hemodialysis patients in China. The aim of this study was to investigate the cognitive status and risk factors of maintenance hemodialysis population. Objects and methods: this study is a cross-sectional investigation. From January 2012 to March 2012, 71 patients were treated with maintenance hemodialysis in the third Hospital of Hebei Medical University. The primary diseases were chronic glomerulonephritis in 28 cases (39.4%) and diabetic nephropathy in 11 cases (15.5%). Renal damage was found in 9 cases (12.7%). The average age was 53.1 鹵15.8 years old, 37 cases were male (52.1%), 34 cases were female (47.9%). The dialysis time was 4 ~ 140 months and the average dialysis time was 4 ~ 140 months, with an average of 39.7 鹵29.6 months. Sex, age, age of dialysis, primary disease, medical history and other personal information were recorded in 71 participants, and blood pressure was recorded before dialysis for 10 times, and the blood pressure was changed during dialysis. The Chinese version of the Montreal scale was used to assess the cognitive function of the neuropsychological test (those with less than 12 years of education plus 1 score, with a total score of 26 points) were assessed by the same investigator according to the standard guidance language. The subjects were tested with neuropsychological scale and the results were recorded accurately. The completion time of all scales was before dialysis treatment. Some blood samples were collected before hemodialysis treatment. Part of the patients underwent lateral plain radiography to observe the calcification of the abdominal aorta, and the vascular calcification score was evaluated by the radiologist according to the foreign scoring standard. Results: all 71 patients completed the scale, with an average score of 22.9 鹵4.3, in which 45 patients had a score of less than 26 and 26 patients had a score greater than 26. Therefore, the incidence of cognitive impairment in this study was 63.4%. The patients were divided into two groups: cognitive impairment group and non-cognitive impairment group. There was significant difference in the proportion of primary diabetic nephropathy (P < 0.05). Gender composition, serum albumin level was different, but 0.05 P 0.10, the result tended to have statistical significance. However, there were no significant differences in dialysis age, abdominal aortic calcification level, hemoglobin level, blood pressure level before dialysis, changes in blood pressure during dialysis, cerebrovascular accident history and body mass index between the two groups (P0.10). Then multiple stepwise regression analysis was carried out on the influential factors which had or tended to be statistically significant. Finally, women (OR=3.542,P0.05) and low educational level (OR=-O.803,P0.05) were identified as independent risk factors for cognitive impairment. Conclusion: cognitive impairment is common in maintenance hemodialysis patients. Women are more likely to suffer from cognitive impairment than men, and the shorter the time of education, the greater the likelihood of cognitive impairment.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R749.1

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