慢性心功能衰竭患者认知功能对自我护理的影响

Influence of Cognitive Function on Self-care in Patients with Chronic Heart Failure

目的探讨慢性心功能衰竭患者认知功能对自我护理的影响,识别认知受损的患者,以期引起护理人员对慢性心功能衰竭患者认知功能的关注,为优先对认知受损患者提供实施延续性护理服务提供依据。方法对北京阜外心血管病医院慢性心功能衰竭监护病房及内科重症监护病房的152例住院慢性心功能衰竭患者,使用蒙特利尔认知功能评估表和心功能衰竭自我护理指数量表进行调查。结果以24分为界值,发现21.3%的患者伴认知功能损伤;其中延迟回忆、语言、视空间与执行功能维度受损较严重;多元线性回归分析结果显示,年龄、心功能分级、抑郁状况及认知功能对自我护理维持变异的解释度为30.1%,其中认知功能占21.5%;认知功能对自我护理管理及自我护理信心变异的解释度分别为29.2%和36.5%。结论慢性心功能衰竭患者的认知功能影响了其自我护理,医务人员在临床工作中应识别认知受损的慢性心功能衰竭患者并对其优先实施延续性护理。

Objective To explore the influence of cognitive function on self-care in patients with chronic heart failure, to screen out patients with cognitive impairment and to provide priority for them in continuous care service. Methods With a cross-sectional study, patients with heart failure（n =152） were recruited from Heart Failure Care Unit and Intensive Care Unit of a hospital specialized in cardiovascular disease in Beijing. The cognitive function and the level of self-care were measured through the Montreal Cognitive Assessment and Self-Care in Heart Failure Index. Results The Montreal Cognitive Assessment score showed that 21.3% of the patients（scored〈 24） suffered from cognitive impairment and their delayed memory, langue, visual spatial and executive capability were impaired most seriously. Multiple regression analysis indicated that age, New York Heart Association Class, depression and cognitive function accounted for 30.1% of the total variance in self-care maintenance; the Montreal Cognitive Assessment score explained 21.5%, 29.2% and 36.5% of the variance in self-care maintenance, management and confidence respectively. Conclusion Cognitive impairment, a hidden co-morbidity, may impede patients＇ ability of self-care. The patients with cognitive impairment should be screened out and provided with priority in continuous care service.