基于RBANS的冠心病患者认知功能测定及影响因素分析

摘要

目的：应用可重复的成套神经心理状态测量（RBANS）测定冠心病患者的认知功能并研究可能影响RBANS评分的因素。方法：选取自2012年3月至2012年10月间在温州医科大学附属第一及附属第二医院心血管内科诊断为冠状动脉粥样硬化性心脏病并住院治疗的患者38例（病例组）及同期健康体检者32例（对照组），对所有研究对象进行RBANS以及汉密尔顿焦虑（HAMA）、汉密尔顿抑郁（HAMD）、D型人格量表测定，同时测定患者冠状动脉粥样硬化程度、NYHA心功能分级、超声心动图、血生化指标等。结果：在RBANS测定中，病例组总分、即刻记忆、视觉广度及延时记忆的得分比对照组低，差异有统计学意义（P＜0.05）；病例组在焦虑、抑郁情绪及D型人格上得分比对照组高，差异有统计学意义（P＜0.05）；病例组中植入支架数与RBANS总分呈负相关，每搏输出量与RBANS总分、即刻记忆、视觉广度呈负相关，主动脉根部内径与即刻记忆呈负相关，肺动脉压与注意呈正相关，心率与注意呈负相关。结论：冠心病患者可能存在明显的认知功能障碍，主要表现在即刻记忆、视觉广度、延时记忆方面；其认知功能可能受情绪、人格的影响，且与植入支架数、每搏输出量、主动脉根部内径、肺动脉压、心率可能存在一定的关系。%Objective: To detect the feature of cognitive function among patients with coronary heart dis-ease using the repeated neuropsychological test and to study potential factors inlfuencing RBANS score.Meth-ods: Thirty-eight patients with coronary heart disease, who were from Department of Cardiology, the First Afifli-ated Hospital of Wenzhou Medical University and the Second Afifliated Hospital of Wenzhou Medical University, and 32 normal subjects for comparison were both tested using RBANS, HAMA, HAMD, Type D scale-14 during March 2012 to October 2012. The degree of coronary atherosclerosis, grading of cardiac function named NYHA, echocardiography, biochemistry of blood were tested, too.Results: In RBANS test, the scores of patient group were lower than that of the control group in total scale of RBANS, immediate memory, visual span and delayed memory factor programs and the difference was statistically signiifcant (P<0.05). The scores of anxiety, depres-sion and type D personality in patient group were higher than that in the control group, the difference was statisti-cally signiifcant (P<0.05); In patient group, the stent number was negatively correlated with total score of RBANS test, the output of every stroke was negatively correlated with total score of RBANS test, immediate memory and visual span, the aortic root diameter was negatively correlated with immediate memory, the pulmonary artery pressure was positively correlated with attention, the heart rate was negatively correlated with attention.Conclu-sion: Patients with coronary heart disease may exist obvious cognitive dysfunction, which is mainly manifested in the immediate memory, visual span, delayed memory. The cognitive function of patients with coronary heart disease may be affected by patients’ emotion and personality, its cognitive dysfunction may exist certain relation-ships to stent number, output of each stroke, aortic root diameter, pulmonary artery pressure and heart rate.