本文關(guān)鍵詞： 高血壓 注意網(wǎng)絡(luò) 認(rèn)知障礙 老年患者 MoCA 量表　出處：《安徽醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的高血壓是老年人常見的心血管病,發(fā)病率逐年增長。高血壓與認(rèn)知功能的關(guān)系也逐漸引起重視,高血壓患者圍術(shù)期認(rèn)知功能的改變情況以及機(jī)制目前尚不清楚。注意組成認(rèn)知功能的重要部分,有認(rèn)知功能障礙的患者往往都并存有注意網(wǎng)絡(luò)的損害。Fan利用注意網(wǎng)絡(luò)試驗(yàn)測(cè)試(Attention network test,ANT)對(duì)注意網(wǎng)絡(luò)系統(tǒng)進(jìn)行相關(guān)研究,ANT有明確的神經(jīng)解剖定位和遞質(zhì),故利用ANT對(duì)老年人圍術(shù)期注意網(wǎng)絡(luò)進(jìn)行研究有助于揭示圍術(shù)期認(rèn)知功能改變的機(jī)制。本研究主要利用ANT測(cè)試探討老年高血壓患者圍術(shù)期個(gè)體注意網(wǎng)絡(luò)改變的特點(diǎn)。方法實(shí)驗(yàn)一:利用蒙特利爾認(rèn)知量表(Mo CA)評(píng)估老年高血壓患者的認(rèn)知功能。選取有3~5年Ⅰ期未治療的自發(fā)性高血壓病史患者30例,正常血壓組30例,兩組在性別、年齡、受教育程度以及MMSE評(píng)分等方面均無統(tǒng)計(jì)學(xué)差異。運(yùn)用注意網(wǎng)絡(luò)測(cè)試(ANT)評(píng)估3個(gè)注意網(wǎng)絡(luò)(警覺、定向、執(zhí)行控制)的效率。實(shí)驗(yàn)二:我院擇期行單側(cè)關(guān)節(jié)置換(髖關(guān)節(jié)或者膝關(guān)節(jié))且不存在術(shù)前認(rèn)知功能障礙的60歲以上老年患者25例。手術(shù)組在術(shù)前完成MMSE量表評(píng)分以及ANT測(cè)試,術(shù)后第2d及第7d再次進(jìn)行ANT測(cè)試,觀察被試者圍術(shù)期警覺、定向和執(zhí)行控制3個(gè)注意網(wǎng)絡(luò)效率的變化。同時(shí)選擇25例年齡、受教育程度相匹配的老年人作為對(duì)照組,完成MMSE量表評(píng)分,在與手術(shù)組間隔相同的三個(gè)時(shí)間點(diǎn)進(jìn)行ANT測(cè)試以排除學(xué)習(xí)效應(yīng)。實(shí)驗(yàn)三:選擇20名未治療Ⅰ期老年高血壓患者,以及20名年齡、性別以及受教育程度相匹配的60歲以上老年患者作為對(duì)照組,兩組均行擇期單側(cè)關(guān)節(jié)(髖關(guān)節(jié)或膝關(guān)節(jié))置換手術(shù)。所有參與者術(shù)前均完成MMSE量表評(píng)分,分別在術(shù)前和術(shù)后第7d完成ANT測(cè)試。統(tǒng)計(jì)學(xué)處理:采用SPSS 13.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理,P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果實(shí)驗(yàn)一:高血壓組與正常血壓組相比,Mo CA視空間執(zhí)行能力、注意力、延遲回憶和總得分均明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。高血壓患者注意網(wǎng)絡(luò)出現(xiàn)明顯損害,特別是在警覺和執(zhí)行控制網(wǎng)絡(luò)方面。實(shí)驗(yàn)二:手術(shù)組圍術(shù)期平均反應(yīng)時(shí)、正確率無明顯改變,術(shù)后第2d警覺(P=0.004)和執(zhí)行控制(P=0.035)網(wǎng)絡(luò)效率明顯受損,但是術(shù)后第7d恢復(fù)到術(shù)前水平(P=0.349,P=0.342),定向網(wǎng)絡(luò)效率在術(shù)后第2d明顯受損(P0.001)。與術(shù)前相比,術(shù)后第7d定向網(wǎng)絡(luò)效率僅部分恢復(fù)(P0.001)。對(duì)照組三個(gè)注意網(wǎng)絡(luò)效率、平均反應(yīng)時(shí)以及正確率在三個(gè)不同的時(shí)間點(diǎn)結(jié)果比較均無明顯統(tǒng)計(jì)學(xué)差異。實(shí)驗(yàn)三:高血壓組術(shù)后第7d警覺(P=0.007)、定向(P0.001)以及執(zhí)行控制(P=0.005)網(wǎng)絡(luò)效率與術(shù)前相比明顯受損。對(duì)照組術(shù)后第7d警覺(P=0.113)、執(zhí)行控制(P=0.404)網(wǎng)絡(luò)效率與術(shù)前相比無明顯統(tǒng)計(jì)學(xué)差異,定向網(wǎng)絡(luò)效率未恢復(fù)(P0.001)。兩組的術(shù)前正確率與術(shù)后第7d相比均無統(tǒng)計(jì)學(xué)差異。結(jié)論實(shí)驗(yàn)一:未治療的Ⅰ期老年高血壓患者M(jìn)o CA視空間執(zhí)行能力、注意力、延遲回憶和總得分均明顯降低,提示高血壓患者存在認(rèn)知功能損害。高血壓患者注意網(wǎng)絡(luò)出現(xiàn)明顯損害,特別是在警覺和執(zhí)行控制網(wǎng)絡(luò)方面。實(shí)驗(yàn)二:老年患者圍術(shù)期注意網(wǎng)絡(luò)出現(xiàn)明顯損害。術(shù)后第2d老年患者空間記憶執(zhí)行能力明顯受損,然而術(shù)后第7d定向能力未完全恢復(fù),警覺和執(zhí)行控制網(wǎng)絡(luò)效率比定向網(wǎng)絡(luò)效率提前恢復(fù)。實(shí)驗(yàn)三:老年人長期高血壓導(dǎo)致注意網(wǎng)絡(luò)受損,這種損害在術(shù)后加重特別是在警覺和執(zhí)行控制網(wǎng)絡(luò)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.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R614

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本文編號(hào)：1525361