维持性血液透析老年患者认知功能水平的调查研究

Cognitive Impairment and Its Risk Factors in Elder Patients with Ma- intenance Hemodialysis

目的调查维持性血液透析老年患者认知功能状态并探讨其相关危险因素，为维持性血液透析患者慢病管理提供理论依据。方法应用中文版简易精神状态检查量表（mini．mentalstateexamination，CMMSE）和自理能力量表（activityofdailylivingscale，ADL）对112例60岁以上的维持性血液透析患者进行神经心理评估和自理能力评估，记录参与者性别、年龄、文化程度、透析龄、血管通路、原发病、既往病史等基本资料，同时记录最近一次的血红蛋白、血清白蛋白水平等实验室数据。结果112例患者完成调查，平均得分为24．9±5．7，其中75例CMMSE得分小于27分，37例得分大于27分，故本组老年患者认知功能损害发生率为67．0％；按是否发生认知功能损害将患者分为损害组与正常组，比较两组间的一般资料发现，性别构成、年龄构成、受教育程度、糖尿病史、自理能力、血清白蛋白水平存在明显差异，有统计学意义（P〈0．05）；结论在维持性血液透析的老年患者中普遍存在认知功能损害；发生认知功能损害的相关危险因素有年龄构成、受教育程度、糖尿病史、自理能力、血清白蛋白水平；年龄越大、文化程度越低、自理能力越低，发生认知功能损害的可能越大。

Objective To investigate the cognitive status of elder patients with maintenance hemodialysis （MHD） and the risk factors of cognitive impairment in these patients in order to pro- vide clues for the management of chronic patients with MHD. Methods A total of 112 patients at age of 60 or older who received MHD were enrolled in this study. Cognitive performance was evalua- ted by Chinese Simple Mental State Examination Scale （CMMSE） and Activity of Daily Living Scale （ADL） . Clinical data, including gender, age, education level, dialysis duration, vascular ac- cess, primary diseases, and medical history, were recorded, and the last pre-dialysis hemoglobin and serum albumin measurements were obtained. Results The average CMMSE score was 24. 9 ± 5.7. CMMSE score was less than 27 points in 75 cases and 37 cases scored more than 27 points. Thecognitive impairment rate in this cohort was 67.0%. There was significant difference in sex, age, level of education, history of diabetes, self-care ability, and serum albumin level between cogni- tive impairment group and normal group （ P 〈 0.05 ） . Conclusion Cognitive impairment is com- mon in elder MHD patients. The risk factors for cognitive impairment are age, level of education, diabetes, self-care ability and serum albumin levels. The patients with elder age, low education and self-care disability are more likely to develop cognitive impairment.