老年维持性血液透析患者认知功能障碍发生情况及影响因素分析

Occurrence of cognitive impairment and analysis of influential factors in elderly patients with maintenance hemodialysis

目的了解老年维持性血液透析(MHD)患者认知功能障碍(CI)发生情况,并采用logistics回归分析其相关影响因素。方法选择2016年3月至2019年3月于海南医学院国际护理学院行MHD治疗的315例老年患者,采用蒙特利尔认知评估量表(MoCA)评估其CI发生情况,并采用logistics回归分析其相关影响因素。结果315例MHD患者中CI患者202例,发生率为64.13%;单因素分析示CI患者和非CI患者的年龄、婚姻状况、文化程度、透析龄、透析治疗方式、合并症指数(CCI)、血红蛋白(Hb)、白蛋白(Alb)水平比较差异有统计学意义(P<0.05);多因素Logisitic回归分析示年龄、透析龄、低通道血液透析(LFHD)、CCI、Hb是影响MHD患者发生CI的独立危险因素,文化程度是影响MHD患者发生CI的独立保护因素。结论老年MHD患者CI发生率较高,年龄、透析龄、LFHD、CCI、Hb是影响CI的独立危险因素,文化程度是独立保护因素,早期评估干预可有效预防和减轻患者认知功能损害。

Objective To study the occurrence of cognitive impairment(CI)in elderly patients with maintenance hemodialy⁃sis(MHD)and to analyze related factors by logistics regression.Methods A total of 315 elderly patients who underwent MHD in the International School of Nursing,Hainan Medical College from March 2016 to March 2019 were selected as study subjects.The Montreal Cognitive Assessment Scale(MoCA)was used to assess the occurrence of CI,and logistics regression analysis was applied to analyze related factors concerning CI.Results Of the 315 patients with MHD,202 had CI with an incidence rate of 64.13%.Univariate anal⁃ysis showed that there was statistical significance in age,marriage status,educational background,dialysis age,dialysis treatment methods,and the levels of complication index(CCI),hemoglobin(Hb)and albumin(Alb),when comparisons were made between the patients with CI and patients without CI(P<0.05).Multivariate Logistic regression analysis indicated that age,dialysis age,low⁃flux hemodialysis(LFHD),CCI and Hb were independent risk factors for CI in the MHD patients,and the educational background was an independent protective factor affecting CI in the MHD patients.Conclusion The incidence of CI is higher among elderly patients with MHD.Age,dialysis age,LFHD,CCI and Hb are independent risk factors for CI,and educational background is an independent protective factor for those patients.Early evaluation and intervention could effectively prevent and reduce cognitive impairment.