老年维持性血液透析患者躯体衰弱合并认知障碍的影响因素分析

Analysis of influencing factors of physical frailty complicated with cognitive impairment in elderly patients with maintenance hemodialysis

目的了解老年维持性血液透析患者躯体衰弱合并认知障碍的现状及影响因素。方法选取2022年2月—2023年2月在南京市某2所血液净化中心行维持性血液透析治疗的269例老年患者。使用临床衰弱量表和蒙特利尔认知评估量表,筛查有无身体衰弱和认知障碍,将参与者分为4组:正常组、仅有躯体衰弱组、仅有认知障碍组、衰弱合并认知障碍组。通过多元Logistic回归探讨老年MHD患者躯体衰弱合并认知障碍的影响因素。结果269例老年维持性血液透析患者躯体衰弱总的检出率为39.8%,认知障碍的总检出率为62.8%,仅有躯体衰弱的检出率7.1%,仅有认知障碍的检出率27.9%,躯体衰弱合并认知障碍的检出率34.9%。多元Logistic回归分析显示:握力(OR=0.829,95%CI:0.736~0.933,P<0.01)、抑郁得分(OR=3.201,95%CI:2.028~5.054,P<0.001)、社会隔离得分(OR=0.788,95%CI:0.703~0.883,P<0.001)、查尔森合并症指数(OR=2.677,95%CI:1.528~4.688,P<0.001)是老年维持性血液透析患者躯体衰弱合并认知障碍的影响因素。结论临床上应关注老年维持性血液透析患者的抑郁、社会隔离、握力、查尔森合并症指数情况,早期识别与干预,延缓身体功能衰退,提高生存质量。

Objective To investigate the current situation and influencing factors of physical frailty complicated with cognitive impairment in elderly patients with maintenance hemodialysis(MHD).Methods A total of 269 elderly patients who underwent MHD in two blood purification centers in Nanjing from February 2022 to February 2023 were selected.The Clinical Frailty Scale and Montreal Cognitive Assessment Scale were used to screen for physical frailty and cognitive impairment.The participants were divided into four groups:normal group,only physical frailty group,only cognitive impairment group,and physical frailty complicated with cognitive impairment group.Multivariate logistic regression was used to investigate the factors affecting physical frailty complicated with cognitive impairment in elderly MHD patients.Results In 269 elderly MHD patients,the total detection rate of physical frailty was 39.8%,the total detection rate of cognitive impairment was 62.8%,the detection rate of only physical frailty was 7.1%,the detection rate of only cognitive impairment was 27.9%,and the detection rate of physical frailty complicated with cognitive impairment was 34.9%.Multiple logistic regression analysis showed that grip strength(OR=0.829,95%CI:0.7360.933,P<0.01),depression score(OR=3.201,95%CI:2.0285.054,P<0.001),social isolation score(OR=0.788,95%CI:0.7030.883,P<0.001)and Charlson Comorbidity Index(OR=2.677,95%CI:1.5284.688,P<0.001)were the influential factors of physical frailty complicated with cognitive impairment in elderly MHD patients.Conclusion In clinical practice,attention should be paid to the depression,social isolation,grip strength,and Charlson Comorbidity Index of elderly MHD patients.Early identification and intervention maybe delay physical function decline and improve the quality of life.