慢性阻塞性肺疾病合并呼吸衰竭影响睡眠和认知功能的相关因素及其机制  

Effects and related mechanisms of chronic obstructive pulmonary disease combined with respiratory failure on sleep and cognitive function

作　　者：王建华[1] 胡贵芳[1] 王力[2] 

机构地区：[1]四川省自贡市第三人民医院呼吸科,643020 [2]四川省自贡市第三人民医院神经内科,643020

出　　处：《中华肺部疾病杂志（电子版）》2017年第6期713-717,共5页Chinese Journal of Lung Diseases(Electronic Edition)

摘　　要：目的探讨可能影响慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者睡眠、认知功能的相关因素及其机制,为提高临床医师认识,及时干预、治疗寻求佐证。方法采用匹兹堡睡眠质量指数量表(PSQI)、蒙特利尔认知功能评定量表(Mo CA)、简易智能精神状态检查量表(MMSE)分别对确诊COPD合并呼吸衰竭、COPD非呼吸衰竭、健康成人对照组患者进行睡眠情况及认知功能评估;比较各组研究对象之间基本资料及睡眠、认知功能情况的差异。结果 COPD呼吸衰竭组PSQI评分高于非呼吸衰竭组及正常对照组,而Mo CA及MMSE总分明显降低,各组间总评分差异有统计学意义(P<0.05)。呼吸衰竭组尤其是II型呼吸衰竭组较正常对照组及非呼吸衰竭COPD组空间执行、命名、注意集中、语言计算、抽象思维及回忆能力评分明显降低,差异有统计学意义。其中短期回忆无明显差异,延迟回忆差异有统计学意义(P<0.05)。Mo CA、MMSE评分均与Pa CO2、乳酸、m MRC、CAT评分呈负相关,与Pa O2、肺功能FEV1%pred呈正相关,差异具有统计学意义(P<0.05)。结论 COPD患者存在广泛的认知功能损害,随着病情加重,认知功能损害更加明显。呼吸衰竭可能是导致COPD患者睡眠异常及认知功能障碍的重要因素之一,其机制与低氧血症、高碳酸血症、高乳酸血症等有关。Objective To investigate the factors and mechanisms which may affect the sleep and cognitive function of patients with chronic obstructive pulmonary disease( COPD) and respiratory failure. To improve the clinical understanding and to find the evidences in order to intervene and treat in time. Methods The Pittsburgh sleep quality index( PSQI) scale. Montreal cognitive function( Mo CA) and mini-mental state examination( MMSE) were used to evaluate the sleep and cognitive function in COPD groups and the healthy adult control group. The baseline data,sleep,and cognitive functions were then compared and analyzed.Results The PSQI scores of COPD patients in respiratory failure group were higher than those in Non respiratory failure group and normal control group,but the total scores of MoCA and MMSE was obviously lower.The differences of total scores between each groups were statistically significant( P < 0. 05). The spatial execution,nomenclature,concentration of attention,language calculation,abstract thinking and recall scores were significantly lower in patients with COPD combined with respiratory failure,especially combined with typeⅡ respiratory failure. By contrast,there were no significant differences in short-term recall between the groups,but the differences in delayed recall were statistically significant( P<0.05). Mo CA score and MMSE score were negatively correlated with PaCO_2,lactic acid,m MRC and CAT scores,and positively correlated with PaO_2 and FEV1% pred. These correlations are statistically significant( P<0.05). Conclusions Patients with COPD have extensive cognitive impairment. And as the disease worsens, cognitive impairment is more pronounced.Respiratory failure may be one of the most important factors that aggravate the abnormal sleep and cognitive dysfunction in COPD patients. Its mechanism is related to hypoxemia,hypercapnia,lactic acidosis and so on.

关 键 词：肺疾病 慢性阻塞性 呼吸衰竭 睡眠 认知功能 

分 类 号：R563[医药卫生—呼吸系统]