急性缺血性卒中患者血管性认知障碍特点及其对功能预后的影响

Characteristics of vascular cognitive impairment of acute ischemic stroke and its effect on functional prognosis

目的探讨急性缺血性脑卒中患者血管性认知功能障碍特点及其对功能预后的影响。方法纳入2017年9月~2018年9月在我院住院的103例被确诊为VCI的急性缺血性脑卒中患者为研究对象,出院时分别使用美国国立卫生研究院脑卒中量表(NIHSS)、简易精神状态量表(MMSE)、改良Barthel指数评定量表(MBI)、改良Rankin量表(mRS)对患者进行评估,结合住院期间血管性认知障碍评估结果对患者进行分析。结果VCI患者的四个维度分布从到高到低为视空间功能、执行功能、记忆功能和语言功能。男性语言功能障碍显著偏低(P<0.05);双侧与单侧在四个维均有差异性(P<0.05),左侧语言功能障碍显著高于右侧(P<0.05);住院时间方面,视空间障碍患者、执行功能障碍患者(P<0.05)住院时间明显偏长;四个维度的年龄分布无差异性(P>0.05);与非记忆障碍患者相比,记忆障碍患者MMSE评分明显偏低(P<0.05);与非视空间障碍患者相比,出院时视空间障碍患者NIHSS评分明显偏高(P<0.05),MMSE和MBI评分均明显偏低(P<0.05);与非语言功能障碍患者相比,出院时语言障碍患者MMSE评分明显偏低(P<0.05);与非执行功能障碍患者相比,出院时执行功能障碍患者NIHSS评分明显偏高(P<0.05),MMSE和MBI评分均明显偏低(P<0.05)。结论急性缺血性卒中患者出现血管性认知障碍的概率高,其中视空间障碍和执行功能障碍对患者功能预后的影响明显。

Objective To explore the characteristics of vascular cognitive dysfunction in patients with acute ischemic stroke and its influence on functional prognosis.Methods 103 out of 125 patients with acute ischemic stroke admitted from September 2017 to September 2018 were enrolled in the study.The patients were assessed with NIHSS,MMSE,MBI and mRS respectively.The evaluation results of vascular cognitive impairment during hospitalization were analyzed.Results Male language dysfunction was significantly lower(P<0.05).The bilateral and unilateral language dysfunction was significantly higher than that of right(P<0.05).The length of stay in hospital was significantly longer in patients with visual spatial disorder and executive dysfunction(P<0.05).There was no difference in age distribution between the four dimensions(P>0.05).Non memory impairment(P>0.05)MMSE score of patients with memory impairment was significantly lower than that of patients with non visual spatial impairment(P<0.05).NIHSS score of patients with visual spatial impairment was significantly higher than that of patients with non visual spatial impairment(P<0.05),MMSE and MBI scores were significantly lower(P<0.05).MMSE score of patients with language impairment was significantly lower than that of patients with non-verbal impairment(P<0.05).MMSE score of patients with non-executive dysfunction was significantly lower than that of patients with non-visual spatial impairment(P<0.05)The NIHSS score of patients with executive dysfunction was significantly higher(P<0.05),MMSE and MBI scores were significantly lower(P<0.05).Conclusion patients with acute ischemic stroke have a high probability of vascular cognitive impairment,in which visual space disorders and executive dysfunction have a significant impact on functional prognosis.