脑梗死后失语患者认知水平康复的相关因素分析

Analysis of related factors of cognitive rehabilitation in patients with aphasia after cerebral infarction

目的探讨影响脑梗死后失语患者认知水平康复的相关因素,以期为临床早期判断及康复治疗提供依据。方法采用目的抽样法,选取2016年9月—2017年9月经西安交通大学第二附属医院治疗的123例脑梗死后失语患者为研究对象,根据3个月后的美国国立卫生研究院脑卒中量表(NIHSS)、简易精神状态检查(MMSE)、汉语失语症评定量表(ABC)、非语言性认知功能评估量表(NLCA)及卒中后失语患者抑郁问卷(医院版)(SADQ-H)评分的增长水平对患者的认知水平康复情况进行评估,并分为良好组92例和不良组31例,对两组患者入院1周后的临床资料进行比较分析。结果单因素分析显示,两组患者在年龄、受教育程度、可支配治疗收入、饮酒史、吸烟史、病灶是否累及皮层以及入院1周NIHSS、ABC、NLCA、SADQ-H评分差异均有统计学意义(P<0.05)。Logistic回归分析显示,年龄≥70岁、有吸烟史、饮酒史、病灶累及皮层以及入院1周NLCA评分是脑梗死后失语患者认知水平康复不良的影响因素(P<0.05)。结论超过70岁的老年患者、既往有吸烟史、饮酒史、发病时病灶累及皮层以及NLCA评分是影响脑梗死后失语患者认知水平康复的危险因素,临床可以此为依据对于具有上述危险因素的患者制定具有针对性的干预措施。

Objective To explore the factors that affect the cognitive rehabilitation of aphasia after cerebral infarction,so as to provide reference for early diagnosis and rehabilitation.Methods A total of 123 patients with post-infarct aphasia who were hospitalized in the Second Affiliated Hospital of Xi'an Jiaotong University from September 2016 to September 2017 were selected as the study subjects.Patients'cognitive status was assessed based on the increase in scores of the National Institute of Health Stroke Scale(NIHSS),Mini-Mental State Examination(MMSE),Aphasia Battery of Chinese(ABC),Non-Language-Based Congnitive Assessment(NLCA),and Stroke Aphasic Depression Questionnaire Hospital Version(SADQ-H)after 3 months.The level of rehabilitation was evaluated and divided into two groups:good group(n=92)and bad group(n=31).The clinical data of the two groups after 1 week of onset were compared and analyzed.Results Univariate analysis revealed that differences in age,education level,disposable income,drinking history,smoking history,whether the lesions involved the cortex,and NIHSS score,ABC score,NLCA score,and SADQ-H score between the two groups were statistically significant(P<0.05).Logistic regression analysis showed that age equal to or over 70 years,smoking history,drinking history,involvement of lesions in the cortex,and 1 week in hospital of NLCA score were all independent risk factors for cognitive impairment in patients with aphasia after cerebral infarction(P<0.05).Conclusions Elderly patients over 70 years of age,previous history of smoking and drinking,involvement of lesions in the cortex,and NLCA score are risk factors for cognitive rehabilitation in patients with aphasia after cerebral infarction.Based on this,we can formulate targeted interventions for patients with the above risk factors.