本文關(guān)鍵詞： 卒中后認(rèn)知功能障礙 腦梗死 高血壓 尿酸 同型半胱氨酸 C-反應(yīng)蛋白 脈壓 程序性降壓 MMSE MoCA　出處：《泰山醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的 1.通過對(duì)急性腦梗死伴高血壓患者進(jìn)行程序性降壓，研究程序性降壓對(duì)卒中后認(rèn)知功能的影響。 2.研究急性腦梗死伴高血壓患者程序性降壓后認(rèn)知功能改變的相關(guān)影響因素。 研究方法 1.收集自2011年9月至2013年3月期間在中國人民解放軍第八十八醫(yī)院住院的急性腦梗死伴高血壓病患者204例，隨機(jī)分為實(shí)驗(yàn)組及對(duì)照組，實(shí)驗(yàn)組予以程序性降壓治療，對(duì)照組不予以降壓治療，收集患者入院時(shí)基線資料并采用上海北辰軟件有限公司的認(rèn)知功能檢測儀進(jìn)行MMSE、MoCA、HIS、HAMD量表檢測，于患者發(fā)病后3個(gè)月、12個(gè)月進(jìn)行隨訪，復(fù)測患者認(rèn)知功能及神經(jīng)功能，比較兩組認(rèn)知功能差異。 2.隨訪3月、12月，研究急性腦梗死伴高血壓患者發(fā)生卒中后認(rèn)知功能障礙的危險(xiǎn)因素，并研究尿酸、同型半胱氨酸、C-反應(yīng)蛋白及脈壓在程序性降壓后卒中后認(rèn)知功能障礙患者中發(fā)揮作用。 結(jié)果 1.基線時(shí)實(shí)驗(yàn)組及對(duì)照組的MMSE及MoCA評(píng)分無明顯差異（P0.05），3月時(shí)對(duì)照組MMSE及MoCA評(píng)分分別為（22.23±4.52）、（19.41±4.62），實(shí)驗(yàn)組為（24.90±3.58）、（22.39±4.08），對(duì)照組認(rèn)知功能評(píng)分低于實(shí)驗(yàn)組（P0.05）。12月時(shí)對(duì)照組MMSE及MoCA評(píng)分分別為（20.74±4.57）、（18.23±5.10），實(shí)驗(yàn)組為（25.44±3.79）、（22.31±4.29），對(duì)照組認(rèn)知功能評(píng)分低于實(shí)驗(yàn)組（P0.05）。 2.3月時(shí)對(duì)照組卒中后認(rèn)知功能障礙的發(fā)病率為35.0%，，實(shí)驗(yàn)組為19.2%，對(duì)照組發(fā)病率高于實(shí)驗(yàn)組（P0.05）。12月時(shí)對(duì)照組卒中后認(rèn)知功能障礙的發(fā)病率為55.0%，實(shí)驗(yàn)組為28.8%，對(duì)照組高于實(shí)驗(yàn)組（P0.05）。 3.卒中后認(rèn)知功能障礙組與認(rèn)知功能正常組間性別構(gòu)成比、房顫、高脂血癥無差異（P0.05）；兩組間年齡、受教育年限、糖尿病、脈壓、程序性降壓、尿酸、同型半胱氨酸、C-反應(yīng)蛋白存在差異（P0.05），將有差異的危險(xiǎn)因素引入非條件多因素Logistic回歸模型分析后，糖尿病被剔除，程序性降壓、高受教育年限為保護(hù)性因素，年齡、脈壓、尿酸、同型半胱氨酸、C-反應(yīng)蛋白為危險(xiǎn)因素。 4.隨訪程序性降壓組患者至3月、12月，入院時(shí)高尿酸血癥組認(rèn)知功能評(píng)分優(yōu)于非高尿酸血癥組（P0.05）；高同型半胱氨酸血癥組認(rèn)知功能評(píng)分低于同型半胱氨酸正常組（P0.05）；C-反應(yīng)蛋白增高組認(rèn)知功能評(píng)分低于C-反應(yīng)蛋白正常組（P0.05）；脈壓增高組認(rèn)知功能評(píng)分低于非脈壓增高組（P0.05）。 研究結(jié)論 1.程序性降壓可能會(huì)改善急性期腦梗死伴高血壓患者3月、12月的認(rèn)知結(jié)局，降低3月、12月時(shí)卒中后認(rèn)知功能障礙的發(fā)生率。 2.年齡、尿酸、同型半胱氨酸、C-反應(yīng)蛋白及脈壓為急性期腦梗死伴高血壓患者發(fā)生卒中后血管性認(rèn)知功障礙的危險(xiǎn)因素，程序降壓、高受教育年限為保護(hù)性因素。 3.尿酸、同型半胱氨酸、C-反應(yīng)蛋白及脈壓與程序性降壓后急性腦梗死伴高血壓患者的認(rèn)知功能呈負(fù)相關(guān)。 研究意義 該實(shí)驗(yàn)研究了程序性降壓對(duì)認(rèn)知功能結(jié)局的影響，并對(duì)認(rèn)知功能障礙有關(guān)危險(xiǎn)因素進(jìn)行了系統(tǒng)研究，提供了大量的真實(shí)、詳盡的臨床資料，為急性期腦梗死患者程序性降壓安全性進(jìn)一步提供了證據(jù)。
[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.

【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3;R544.1

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