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

【摘要】：目的探討用LOTCA量表評定單病灶腦出血患者早期認知功能障礙的特點及認知障礙與焦慮、抑郁之間的相關性,并探討影響認知障礙的相關因素。 方法依據(jù)設定的腦出血病例組與健康對照組納入和排除標準,選取2013年03月至2014年02月在昆明醫(yī)科大學第一附屬醫(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、陪護人員、醫(yī)務人員等健康人群50名為健康對照組,評定時間為發(fā)病后半個月之內(nèi)。應用洛文斯頓作業(yè)療法認知評定中文量表(Loewenstein Occupational Therapy Cognitive Assessment Second Edition, LOTCA)(第二版)從定向、知覺、動作運用、視運動組織、思維操作、注意力等方面評估研究對象的認知情況；兩組比較是否有差異。按照年齡、受教育程度、各相關因素等將腦出血病例組進行分組評估,分析這些因素與量表得分之間的相關性。Zung氏抑郁自評量表(SDS)和Zung氏焦慮自評量表(SAS)評定其是否有抑郁焦慮狀態(tài)。 結果1.腦出血病例組與健康對照組認知功能結果比較：認知功能LOTCA總得分、各子項目及各次級子項目得分,腦出血病例組得分均較低,差異有統(tǒng)計學意義(P0.05)；2.腦出血患者認知功能LOTCA得分與SDS、SAS等級評分三者間相關分析：①認知功能LOTCA總得分與SDS、SAS等級評分有相關性(r=0.320, r=0.481, P＜0.05);②其中定向力、視知覺、空間知覺、動作運用、視運動組織和思維操作的LOTCA得分與SDS、SAS等級評分相關性的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)計學意義(P0.05)。4.老年、吸煙、飲酒、高血壓、血糖異常、血脂異常、發(fā)病時血腫大、破入腦室的腦出血患者認知功能LOTCA得分較對照組得分低(P0.05),性別、不同側腦出血患者的認知功能LOTCA得分比較(P0.05),但進一步行多重回歸分析示患者住院時譫妄或煩躁、年齡大、低教育水平、高血壓、不同側腦出血的P值均很小(P0.05),說明進入方程的5個因素都有作用。 結論1.單病灶腦出血患者存在一定程度的早期認知功能障礙,出現(xiàn)定向、視知覺、空間知覺、動作運用、視運動組織、思維操作認知功能的廣泛損害。2.抑郁、焦慮影響腦出血患者早期認知功能。3.患者住院時譫妄或煩躁、年齡大、低教育水平、高血壓、不同側腦出血可能對腦出血患者認知障礙的發(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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.34

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