老年脑梗死后认知障碍发生的危险因素分析  

Risk factoanalysiof cognitive impairmenof elderly patientaftecerebral infarction

作　　者：雷军[1] 王淑娟[1] 刘业松[1] 薛斌[2] 崔燕[1] 孟令民[1] 张楠楠[1] 张萍淑[1] 元小冬[1] 

机构地区：[1]河北联合大学附属开滦总医院神经内科,河北省唐山市063000 [2]河北省邯郸市第一医院神经内科

出　　处：《中国综合临床》2015年第2期114-117,共4页Clinical Medicine of China

摘　　要：目的探讨老年脑梗死后认知障碍发生的危险因素，为临床干预提供理论依据。方法选择于2010年3月至2013年6月入住开滦总医院的老年脑梗死患者共237例，入院后核实一般情况、既往史以及辅助检查。于发病后1—2周内参照脑梗死后认知障碍的诊断标准及MoCA量表，MoCA〈26分者认为存在认知功能障碍，MoCA326分者认知功能为正常。采用单因素分析老年脑梗死后认知障碍发生的危险因素，并将有意义的指标纳入多因素非条件Logistic回归方程进一步分析。结果不同性别脑梗死患者认知障碍发病率比较差异无统计学意义（P〉0．05）；75岁以上、低受教育者发病率显著高于年龄偏小、教育程度高者（x2值分别为16．661、5．453，P均〈0．05）；脑力劳动者发病率显著低于体力劳动者（X2=5．458，P〈0．05）；基础疾病存在高血压、糖尿病、心脏病和脑白质疏松患者的发病率明显高于无上述疾病者（x2值分别为28．423、5．621、7．786、6．070，P均〈0．05）；吸烟多者发病率明显高于吸烟较少或不吸烟者（x2=5．045，P〈0．05）。多因素非条件Lostic回归分析显示：老年脑梗死发生后2周内67例出现认知障碍，其发生的独立危险因素包括：年龄〉75岁（P=0．000）、糖尿病（P=0．043）、高血压（P=0．000）、脑白质疏松（P=0．041）、吸烟（P=0．035）。结论老年脑梗死后发生认知障碍的危险因素较多，干预需从多方面入手，需及早排查发现。Objective To explore the risk factorof cognitive impairmenof elderly patientwith cerebral infarction in ordeto provide the theoretical basifothe clinical intervention. Methodtotal of 237 casewith senile cerebral infarction were selected aoursubjectwho were hospitalized from Mar. 2010 to Jun. 2013 in Kailuan General Hospital Affiliated to Hebei United University. The general condition and medical history were recorded. The auxiliary examination waperformed. Cerebral infarction wadiagnosed based on the onseto diagnosistandard and MoCscoreof within 2 weeks. The patientwith lesthan 26 MoCscore were diagnosed acognitive dysfunction and otherwise were thoughanormal. Single factoanalysimethodand non conditional Logistiregression were applied to analyze the analysis. ResultThere wano significandifference in termof incidence between patientwith differengender. Patientwith age more than 75 yearold and lowe 2 education levelhad the high incidence rate than those with youngeage and high education level（ X = 16. 661,5.453 ;P 〈 0. 05 ）. The cognitive dysfunction incidence of patientwith white collawalowethan those with blue colla（ X2 = 5.458, P 〈 0. 05 ） . And the cognitive dysfunction incidence of patientwith hypertention, diabetes, heardisease and leukoaraiosiwere highethan those withouthe above disease（X2 = 28.423,5. 621,7. 768,6. 070;P 〈 0.05 ）. The incidence of patientsmoking more wasignificantly highethan thaof smoking lesono （ X2 = 5.045, P 〈 0.05 ）. Multiple factorand non conditional Logistiregression analysishowed that, 67 Senile cerebral infarction patientoccurred cognitive impairmenwithin 2 weeks. The independenrisk factorfoitoccurrence included age greatethan 75 year（ P = 0. 000 ）, diabetemellitu（ P =0. 043） ,hypertension （P =0. 000） and leukoaraiosis（P =0. 041 ）. Conclusion There are many risk factorrelated to cognitive impairmenaftecerebral infarction occurred in the elderly. The intervention should take in many aspectand the risk factorshould early found.

关 键 词：脑梗死 认知障碍 危险因素 老年人 

分 类 号：R541.4[医药卫生—心血管疾病]