脑梗死后痴呆的危险因素分析及多奈哌齐的治疗效果研究

摘要

Objective To explore the risk factors of dementia after cerebral infarction,and to study the therapeutic effect of donepezil. Methods A total of 150 patients with cerebral infarction who admitted to The First People′s Hospital of Shi-zuishan City,hospital from May 2009 to May 2012,were selected as study subjects,among whom 47 cases(31. 3% )had de-mentia. The risk factors of dementia after cerebral infarction were analyzed by univariate analysis and multivariate Logistic regres-sion analysis. The patients with dementia after cerebral infarction were divided into control group(22 cases)and observation group(25 cases),the control group was given conventional treatment,the observation group was given conventional treatment and donepezil hydrochloride tablets. After 9 months of follow - up,the therapeutic effect,cognitive function and activities of daily living were observed among patients with dementia after cerebral infarction. Results The dementia was related to age,de-gree of education,occupation,diabetes,smoking,hyperlipemia,hyperlipidemia and heart disease among patients with cere-bral infarction( P ﹤ 0. 05). According to Logistic regression analysis results,age,smoking,diabetes,and hyperlipidemia were the risk infactors for dementia after cerebral infarction and(OR = 1. 107、1. 961、1. 146、1. 148,P ﹤ 0. 05). After 9 months,the therapeutic effect of observation group was better than that of control group( P ﹤ 0. 05). After 6 months and 9 months of treatment,the scores of MoCA and MMSE in observation group were significantly higher than those in control group, the ADL score in observation group was significantly lower than that in control group(P ﹤ 0. 05). Conclusion Advanced age, diabetes,smoking and hyperlipemia were risk factors for dementia after cerebral infarction. Application of donepezil on the basis of routine treatment can obviously improve cognitive function and life function,and has better long - term therapeutic effects.%目的：探讨脑梗死后痴呆的危险因素，并对多奈哌齐治疗脑梗死痴呆的效果进行研究。方法选取2009年5月-2012年5月本院收治的150例脑梗死患者，其中痴呆患者47例（31.3％）。对脑梗死后痴呆的危险因素进行单因素分析和多因素 Logistic 回归分析。将脑梗死后痴呆患者随机分为对照组（22例）和观察组（25例），前者给予常规治疗，后者另加用盐酸多奈哌齐片治疗。随访9个月，观察脑梗死痴呆患者的临床疗效、认知功能及日常生活能力。结果不同年龄、文化程度、职业，是否吸烟，有无高血压、高血脂、糖尿病、心脏病的脑梗死患者痴呆发生率间均不同（P ﹤0.05）。Logistic 回归分析显示，年龄、吸烟、高血脂、糖尿病是脑梗死后痴呆的危险因素（OR ＝1.107、1.961、1.146、1.148，P ﹤0.05）。治疗9个月时，观察组患者的疗效优于对照组（P ﹤0.05）。治疗6、9个月时，观察组患者的蒙特利尔认知功能量表（MoCA）、简明精神状态量表（MMSE）评分均高于对照组，日常生活能力量表（ADL）评分低于对照组（P ﹤0.05）。结论高龄、吸烟、高血脂、糖尿病是脑梗死后痴呆的危险因素。在常规治疗基础上加用多奈哌齐可以改善脑梗死后痴呆患者的认知功能和生活功能，具有较好的远期疗效。