MoCA量表在动脉瘤性蛛网膜下腔出血患者术后早期认知功能中的应用

Application of MoCA scale in early postoperative cognitive function of patients with aneurysmal subarachnoid hemorrhage

目的 探索蒙特利尔认知评估(Montreal cognitive assessment,MoCA)量表在动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,a SAH)患者术后早期认知功能中的应用。方法 选取2021年11月至2022年5月在温州医科大学附属第一医院神经外科住院的181例a SAH患者的临床资料,采用Mo CA量表评估患者术后各维度得分情况。以性别、年龄、受教育程度、高血压、责任动脉瘤内径、Hunt-Hess分级、手术方式等为变量,研究其与MoCA量表各维度得分的关系。采用Logistic回归分析探讨低分维度与术后认知功能的影响因素。结果 认知功能正常(≥26分)61例(36.31%)。语言维度的多因素分析结果示:受教育程度、年龄、手术方式、Hunt-Hess分级等在是否发生认知功能障碍中的比较,差异有统计学意义(P<0.05);延迟记忆的多因素分析结果示:受教育程度、Hunt-Hess分级、酗酒、脑卒中家族史、手术方式等在是否发生认知功能障碍中的比较,差异有统计学意义(P<0.05)。结论 a SAH患者术后早期认知功能障碍发生率高;语言、延迟记忆维度分数最低;低文化背景、高龄、开颅方式、Hunt-Hess高分级等更易造成语言及延迟记忆受损。

Objective To explore the application of the Montreal cognitive assessment(MoCA)scale in the early postoperative cognitive function of patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods The clinical data of 181 patients with aSAH hospitalized in Department of Neurosurgery,First Affiliated Hospital of Wenzhou Medical University from November 2021 to May 2022 were collected,and the scores of each dimension of the patients were evaluated using MoCA scale;Using gender,age,educational level,hypertension,responsible aneurysm diameter,Hunt-Hess grade,and surgical method as variables,the relationship between these factors and the scores of each dimension of the MoCA scale was studied.Logistic regression was used to analyze the influencing factors of low score dimensions and postoperative cognitive function.Results 61 cases(36.31%)had normal cognitive function(≥26 points).The results of multifactorial analysis of language dimensions showed that there was a statistically significant difference in the comparison of educational background,age,surgical method,Hunt-Hess grade,and the presence or absence of cognitive dysfunction(P<0.05);The results of multifactor analysis of delayed memory showed that there was a statistically significant difference in the occurrence of cognitive dysfunction among educational background,Hunt-Hess classification,alcoholism,family history of stroke,and surgical methods(P<0.05).Conclusion The incidence of early postoperative cognitive dysfunction in patients with aSAH is high;The scores of language and delayed memory were the lowest;Low cultural background,advanced age,craniotomy methods,and high Hunt-Hess scores are more likely to cause damage to language and delayed memory dimensions.