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中国人民解放军总医院老年心血管病研究所
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
杨郑,孙颖,崔怡宁,黄樱硕,邢云利,黄蔚.老年慢性心力衰竭认知功能情况分析[J].中华老年多器官疾病杂志,2018,17(3):178~182
老年慢性心力衰竭认知功能情况分析
Cognitive function in the elderly with chronic heart failure
投稿时间:2017-10-11  修订日期:2017-11-21
DOI:10.11915/j.issn.1671-5403.2018.03.039
中文关键词:  老年人;心力衰竭;认知功能障碍
英文关键词:aged; heart failure; cognitive impairment
基金项目:北京市属医院科研培育计划项目(PX2016033)
作者单位E-mail
杨郑 首都医科大学附属北京友谊医院医疗保健中心心血管内科,北京100050;丰盛中医骨伤专科医院内科病房,北京100140  
孙颖 首都医科大学附属北京友谊医院医疗保健中心心血管内科,北京100050 ysun15@163.com 
崔怡宁 首都医科大学附属北京友谊医院医疗保健中心心血管内科,北京100050  
黄樱硕 首都医科大学附属北京友谊医院医疗保健中心心血管内科,北京100050  
邢云利 首都医科大学附属北京友谊医院医疗保健中心心血管内科,北京100050  
黄蔚 首都医科大学附属北京友谊医院医疗保健中心心血管内科,北京100050  
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中文摘要:
      目的 了解老年慢性心力衰竭(CHF)患者认知功能障碍的发病情况,分析合并认知功能障碍的老年CHF患者的临床特点。方法 回顾性分析2015年1月1日至2016年3月1日在北京友谊医院医疗保健中心住院的180例老年CHF患者。根据蒙特利尔认知评估量表评分将180例老年CHF患者分成3组:认知功能正常组(n=44)、轻度认知功能障碍(MCI)组(n=75)和重度认知功能障碍(SMI)组(n=61)。比较3组患者临床特点。采用SPSS 17.0软件进行数据处理。根据数据类型,组间比较采用F检验或χ2检验。对单因素分析有统计学意义的指标进行多因素logistic 回归分析,筛选出独立的危险因素。结果 老年CHF患者中认知功能障碍的患病率为75.6%(136/180)。与正常组相比,MCI组和SMI组中纽约心脏病学会(NYHA) Ⅲ级者显著增加(21.33% vs 47.54% vs 13.64%,P<0.05),SMI组中女性患者(38.64% vs 55.74%)、高中以下学历者(13.64% vs 36.07%)及血糖值[(5.10±0.74) vs(5.88±2.38)mmol/L]显著增加(P<0.05),而血红蛋白值显著降低[(131.50±15.89) vs(122.80±15.61)g/L,P<0.05]。与MCI组相比,SMI组中NYHA Ⅲ级者(21.33% vs 47.54%)、女性患者(32.00% vs 55.74%)及高中以下学历者(17.33% vs 36.07%)显著增多(P<0.05)。SMI组患者的左室射血分数(LVEF)显著低于正常组和MCI组[(61.72±7.81)% vs(64.89±6.58)% vs(64.07±5.88)%,P<0.05]。多因素logistic回归分析,结果发现NYHA Ⅲ级(95%CI:1.21~13.61)和血红蛋白值低下(95%CI:0.94~0.99)是MCI的独立危险因素(P<0.05),NYHA Ⅲ级(95%CI:1.73~21.98)、血红蛋白值低下(95%CI:0.93~0.99)、女性(95%CI:0.15~0.96)、高中以下学历(95%CI:1.36~13.76)和低LVEF(95%CI:1.00~1.15)是SMI的独立危险因素(P<0.05)。结论 老年CHF患者存在认知功能下降。合并认知功能障碍的CHF患者主要临床特点为女性较多、受教育年限较短、心功能分级差、血糖偏高、血红蛋白值及LVEF偏低。
英文摘要:
      Objective To investigate the incidence of cognitive impairment in the elderly patients with chronic heart failure (CHF), and to analyze the clinical characteristics of those suffering from CHF accompanied with cognitive impairment. Methods A retrospective study was carried out on 180 elderly CHF patients who were hospitalized in our health care center from January 1,5 to March 1,6. According to Montreal cognitive assessment, they were divided into 3 groups:normal group (n=44), mild cognitive impairment group (MCI, n=75) and severe cognitive impairment group (SMI, n=61). The clinical characteristics were compared among the 3 groups. SPSS statistics 17.0 was used for data processing. The comparison between the groups was performed by F test or by Chi-square test. Multivariate logistic regression analysis was carried out for single factor analysis with statistical significance, and then independent risk factors were screened out. Results The incidence rate of cognitive impairment was 75.6% (136/180) in the subjected elderly CHF patients. Compared with the normal group, the ratio of those at New York Heart Association (NYHA) Ⅲ was significantly larger in the MCI and SMI groups (47.54% vs 21.33% vs 13.64%, P<0.05). The SMI group had obviously more female patients (55.74% vs 38.64%), higher percentage of patients with education level lower than high school (36.07% vs 13.64%), and higher blood glucose level [(5.88±2.38) vs (5.10±0.74) mmol/L, all P<0.05], but notably lower hemoglobin level[(131.50±15.89) vs (122.80±15.61)g/L, P<0.05]when compared with the normal group. The ratios of NYHA Ⅲ (47.54% vs 21.33%), female patients (55.74% vs 32.00%) and lower educational level than high school (36.07% vs 17.33%) were significantly larger in the SMI group than in the MCI group (P<0.05). Left ventricular ejection fraction (LVEF) in the SMI group was significantly lower than those of the normal group and MCI group [(61.72±7.81)% vs (64.89±6.58)% vs (64.07±5.88)%, P<0.05]. Multivariate logistic regression analysis showed that NYHA Ⅲ level (95%CI:1.21-13.61), and low hemoglobin level (95%CI:0.94-0.99) were independent risk factors for MCI (P<0.05), while NYHA Ⅲ level (95%CI:1.73-21.98), low hemoglobin level (95%CI:0.93-0.99), female (95%CI:0.15-0.96), lower educational level than high school (95%CI:1.36-13.76) and low LVEF (95%CI:1.00-1.15) were independent risk factors for SMI (P<0.05). Conclusion The elderly CHF patients commonly suffer declined cognitive function. Those patients with cognitive impairment are characterized by female, low educational level, poor heart function classification, high blood glucose, low hemoglobin level and LVEF.
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