伴有慢性心力衰竭的老年急性脑卒中患者认知功能临床特点分析

摘要

目的 探讨伴有慢性心力衰竭的老年急性脑卒中患者认知功能的临床特点.方法 回顾性分析我院因急性脑卒中住院的老年慢性心力衰竭患者331例,符合入选条件的患者共217例,根据LVEF分为射血分数减低的心力衰竭(HFrEF)组77例、射血分数中间值的心力衰竭(HFrnrEF)组46例和射血分数保留的心力衰竭(HFpEF)组94例.收集患者的临床资料,包括基本人口学资料、病史、认知功能评分量表以及本次脑卒中责任病灶部位等,比较3组资料并进行统计学分析.结果 HFrEF组入院收缩压、蒙特利尔认知评估量表(MoCA)评分显著低于HFmrEF组和HFpEF组,持续性心房颤动、糖尿病、心率和糖化血红蛋白水平显著高于HFmrEF组和HFpEF组,差异有统计学意义(P＜0.05,P＜0.01).HFpEF组左心室肥厚比例高于HFrEF组和HFmrEF组(P＜0.01).认知障碍的总体发生率为54.8％,其中HFrEF组为66.2％,HFmrEF组为50.0％,HFpEF组为47.9％.logistic回归分析显示,持续性心房颤动、收缩压以及糖尿病是认知障碍的危险因素(OR=2.757,P=0.017;OR=0.971,P=0.001;OR=2.293,P=0.031).结论 伴有慢性心力衰竭的老年患者急性脑卒中后认知障碍发生率较高,认知障碍的危险因素有持续性心房颤动、糖尿病病史以及收缩压降低,要重视对患者的认知功能评估.%Objective To study the clinical characteristics of cognitive function in elderly acute stroke (AS) patients with CHF.Methods Two hundred and seventeen elderly AS patients with CHF were devided into HFrEF group (n=77),HFmrEF (n=46) and HFpEF group (n=94) according to their LVEF.Their clinical data (including baseline demographic data,history of disease,NIHSS score,MMSE score,MoCA score,responsible lesions) were recorded and analyzed.Results The SBP and total MoCA score were significantly lower while the incidence of persistant AF,DM and serum HbA1C level were significantly higher in HFrEF group than in HFmrEF group and HFpEF group (P＜0.05,P＜0.01).The incidence of left ventricular hypertrothy was higher in HFpEF group than in HFmrEF group and HFpEF group (P＜0.01).The total incidence of cognitive impairment was 54.8％ in 217 AS patients with CHF.Logistic regression analysis showed that persistant AF,SBP and DM were the risk factors for cognitive impairment (OR=2.757,P=0.017;OR=0.971,P=0.001;OR=2.293,P=0.031).Conclusion The incidence of cognitive impairment is rather high in elderly AS patients with CHF.Persistant AF,DM and SBP are the risk factors for cognitive impairment.Attention should thus be paid to the assessment of cognitive impairment in elderly AS patients with CHF.