慢性阻塞性肺疾病急性加重期患者认知障碍临床分析

Clinical analysis on cognitive impairment in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)住院患者认知功能障碍的相关因素。方法选择AECOPD患者110例及同期健康志愿者100例,采用中文版蒙特利尔认知评估量表(Mo CA),比较两组的认知功能,并观察AECOPD患者不同肺功能情况、PaO_2水平、PaCO_2水平及住院治疗前后的认知功能差异。结果 110例AECOPD患者中98例(89.09%)患者存在认知功能障碍。与对照组相比较,AECOPD组患者Mo CA评分在视空间与执行、延迟记忆、命名、语言、注意、抽象、定向、计算力各分项及总分均显著降低,差异具有统计学意义(P<0.05)。根据AECOPD患者不同肺功能、Pa O_2水平、PaCO_2水平及住院治疗前后分别分组,肺功能较好组、Pa O2≥60 mm Hg组、Pa CO_2<50 mm Hg组及治疗后组较肺功能较差组、PaO_2<60 mm Hg组、PaCO_2≥50 mm Hg组及治疗前组患者Mo CA评分在各分项及总分均显著升高,差异有统计学意义(P<0.05)。多元逐步线性回归显示,年龄、文化程度、肺功能、PaO_2及PaCO_2是导致AECOPD患者认知功能障碍的主要因素。结论 AECOPD患者普遍存在认知功能障碍,有效的住院治疗可以改善患者的认知功能,年龄、文化程度、肺功能、PaO_2降低及PaCO_2升高与其认知功能下降有关。

Objective To explore the related factors of cognitive dysfunction in patients with acute exacerbation of chronic obstructive pulmonary disease（ AECOPD）. Methods 110 patients with AECOPD and100 healthy volunteers were selected,and the Chinese version of the Montreal cognitive assessment scale（ Mo CA）was used to compare the cognitive function of the two groups,and to observe the differences in the cognitive function of AECOPD patients with different lung function,PaO_2 and Pa CO2 before and after hospitalization.Results 98 in 110（ 89. 09%） patients with AECOPD had cognitive dysfunction. Compared with the control group,the Mo CA score in the AECOPD group was significantly decreased in the visual structure space and executive function,naming,delayed memory,attention,language,abstract,orientation,calculation power and the total score,the differences were statistically significant（ P 0. 05）. According to different lung function,PaO_2 level,Pa CO2 level and the treatment before and after hospitalization,AECOPD patients were grouped as Lung function better group,PaO_2≥60mm Hg group Pa CO2 50 mm Hg group and poor lung function group,PaO_260mm Hg group,Pa CO2≥50mm Hg before treatment group. All groups got improvement in Mo CA score in each item and the total score,and the differences were statistically significant（ P 0. 05）. Multivariate linear regression analysis showed that age,education level,lung function,PaO_2 and Pa CO2 were the main factors affecting the cognitive function of AECOPD patients. Conclusions A majority of AECOPD patients with cognitive dysfunction,effective hospitalization can improve the cognitive function of patients. Age,education level,lung function,PaO_2 decreasing and Pa CO2 increasing were correlated with the decline of cognitive function.