本文選題：腦出血　切入點(diǎn)：認(rèn)知障礙　出處：《昆明醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討用LOTCA量表評(píng)定單病灶腦出血患者早期認(rèn)知功能障礙的特點(diǎn)及認(rèn)知障礙與焦慮、抑郁之間的相關(guān)性,并探討影響認(rèn)知障礙的相關(guān)因素。 方法依據(jù)設(shè)定的腦出血病例組與健康對(duì)照組納入和排除標(biāo)準(zhǔn),選取2013年03月至2014年02月在昆明醫(yī)科大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科診療的腦出血患者48例為腦出血病例組,以與病例組年齡、性別、教育程度相匹配的患者家屬、陪護(hù)人員、醫(yī)務(wù)人員等健康人群50名為健康對(duì)照組,評(píng)定時(shí)間為發(fā)病后半個(gè)月之內(nèi)。應(yīng)用洛文斯頓作業(yè)療法認(rèn)知評(píng)定中文量表(Loewenstein Occupational Therapy Cognitive Assessment Second Edition, LOTCA)(第二版)從定向、知覺(jué)、動(dòng)作運(yùn)用、視運(yùn)動(dòng)組織、思維操作、注意力等方面評(píng)估研究對(duì)象的認(rèn)知情況；兩組比較是否有差異。按照年齡、受教育程度、各相關(guān)因素等將腦出血病例組進(jìn)行分組評(píng)估,分析這些因素與量表得分之間的相關(guān)性。Zung氏抑郁自評(píng)量表(SDS)和Zung氏焦慮自評(píng)量表(SAS)評(píng)定其是否有抑郁焦慮狀態(tài)。 結(jié)果1.腦出血病例組與健康對(duì)照組認(rèn)知功能結(jié)果比較：認(rèn)知功能LOTCA總得分、各子項(xiàng)目及各次級(jí)子項(xiàng)目得分,腦出血病例組得分均較低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；2.腦出血患者認(rèn)知功能LOTCA得分與SDS、SAS等級(jí)評(píng)分三者間相關(guān)分析：①認(rèn)知功能LOTCA總得分與SDS、SAS等級(jí)評(píng)分有相關(guān)性(r=0.320, r=0.481, P＜0.05);②其中定向力、視知覺(jué)、空間知覺(jué)、動(dòng)作運(yùn)用、視運(yùn)動(dòng)組織和思維操作的LOTCA得分與SDS、SAS等級(jí)評(píng)分相關(guān)性的r值范圍分別為0.190至0.390、0.110至0.481。3.腦出血后有抑郁、焦慮的患者認(rèn)知功能LOTCA總得分較腦出血后非抑郁焦慮狀態(tài)的患者得分低,兩者差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.老年、吸煙、飲酒、高血壓、血糖異常、血脂異常、發(fā)病時(shí)血腫大、破入腦室的腦出血患者認(rèn)知功能LOTCA得分較對(duì)照組得分低(P0.05),性別、不同側(cè)腦出血患者的認(rèn)知功能LOTCA得分比較(P0.05),但進(jìn)一步行多重回歸分析示患者住院時(shí)譫妄或煩躁、年齡大、低教育水平、高血壓、不同側(cè)腦出血的P值均很小(P0.05),說(shuō)明進(jìn)入方程的5個(gè)因素都有作用。 結(jié)論1.單病灶腦出血患者存在一定程度的早期認(rèn)知功能障礙,出現(xiàn)定向、視知覺(jué)、空間知覺(jué)、動(dòng)作運(yùn)用、視運(yùn)動(dòng)組織、思維操作認(rèn)知功能的廣泛損害。2.抑郁、焦慮影響腦出血患者早期認(rèn)知功能。3.患者住院時(shí)譫妄或煩躁、年齡大、低教育水平、高血壓、不同側(cè)腦出血可能對(duì)腦出血患者認(rèn)知障礙的發(fā)生影響較大。
[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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.34

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 吳景芬;肖軍;陳祥慧;馮瓊?cè)A;黃雨蘭;韋永勝;;腦卒中部位與認(rèn)知功能障礙的相關(guān)分析[J];臨床神經(jīng)病學(xué)雜志;2009年04期

2 ;中國(guó)成人血脂異常防治指南[J];中華心血管病雜志;2007年05期

3 郭華珍,惲?xí)云?陳巍;不同腦半球損傷患者認(rèn)知功能障礙的比較[J];中國(guó)康復(fù)理論與實(shí)踐;2002年09期

4 韓寧;丁素菊;吳濤;朱幼麗;;大鼠腦出血模型中神經(jīng)細(xì)胞凋亡與自由基水平的相關(guān)性(英文)[J];Neuroscience Bulletin;2008年06期

，

本文編號(hào)：1603038