老年慢性心力衰竭合并高血压患者认知功能及其影响因素分析

Analysis of cognitive function and the influencing factors in elderly patients with chronic heart failure complicated with hypertension

目的探讨老年慢性心力衰竭(chronic heart failure,CHF)合并高血压患者的认知功能及其影响因素。方法选择2018年3月至2019年12月于阜阳市人民医院就诊的86例老年CHF合并高血压患者为研究对象,采用蒙特利尔认知评估量表评估患者的认知功能,据此分为损伤组和正常组。比较两组患者的临床资料,采用多因素Logistic回归分析探讨老年CHF合并高血压患者认知损害的独立影响因素。结果全部86例患者共有23例出现认知损害,发生率为26.7%。损伤组患者的年龄、汉密尔顿焦虑量表评分、汉密尔顿抑郁量表评分、血肌酐、尿素氮、尿酸、糖化血红蛋白(glycosylated hemoglobin,HbA_(1c))水平、合并糖尿病占比、美国纽约心脏协会心功能分级Ⅳ级占比均显著高于正常组(均P<0.05),高血压病程和CHF病程均显著长于正常组(均P<0.05),受教育时间和6 min步行距离均显著短于正常组(均P<0.05),家庭平均年收入、左心室射血分数(left ventricular ejection fraction,LVEF)、使用β受体阻滞剂占比、社会支持评定量表(social support rating scale,SSRS)评分、血红蛋白(hemoglobin,Hb)水平均显著低于正常组(均P<0.05)。多因素Logistic回归分析结果表明,LVEF、SSRS评分、外周血Hb和HbA_(1c)水平均为老年CHF合并高血压患者认知损害的独立影响因素(均P<0.05)。结论约有1/4的老年CHF合并高血压患者存在认知损害,LVEF、SSRS评分、外周血Hb和HbA_(1c)水平均为此类患者认知损害的独立影响因素。

Objective To investigate the cognitive function and the influencing factors in elderly patients with chronic heart failure(CHF)complicated with hypertension.Method Eighty-six elderly patients with CHF complicated with hypertension treated in Fuyang People's Hospital from March 2018 to December 2019 were enrolled for the study.The cognitive function was assessed by Montreal cognitive assessment scale,and then patients were divided into impairment group and normal group.The clinical data were compared between the two groups,and multivariate Logistic regression analysis was performed to screen out the independent influencing factors of cognitive impairment.Result Twenty-three patients suffered from cognitive impairment in all 86 patients,whose incidence was 26.7%.The age,Hamilton anxiety scale score,Hamilton depression scale score,serum creatinine,urea nitrogen,uric acid,glycosylated hemoglobin(HbA_(1c))level,the proportion of complicated with diabetes mellitus and cardiac function grade Ⅳ of American New York Heart Association in impairment group were significantly higher than those in normal group(all P<0.05),the duration of hypertension and CHF were significantly longer than those of normal group(all P<0.05),while the education time and 6 minutes walking distance were significantly shorter than those of normal group(all P<0.05),the family average annual income,left ventricular ejection fraction(LVEF),the proportion of β-blocker use,social support rating scale(SSRS)score and hemoglobin(Hb)level were significantly lower than those of normal group(all P<0.05).Multivariate Logistic regression analysis showed that LVEF,SSRS score,Hb and HbA_(1c) levels in peripheral blood were independent influencing factors of cognitive impairment in elderly patients with CHF complicated with hypertension(all P<0.05).Conclusion About 1/4 of elderly patients with CHF complicated with hypertension suffered from cognitive impairment.LVEF,SSRS,Hb and HbA_(1c) levels in peripheral blood are the independent factors of cognitive impairment.