围绝经期维持性血液透析患者认知功能变化特点及影响因素分析

目的分析围绝经期维持性血液透析患者认知功能变化特点及其影响因素,为改善患者的健康认知状况提供参考依据。方法选取2018年12月-2020年11月浙江省台州医院诊治的围绝经期维持性血液透析患者138例为研究对象,应用中文版蒙特利尔认知评估量表(MoCA)评估认知功能并分析其变化特点,通过病历记录、调查问卷收集患者的信息资料,包括患者年龄、受教育年限、月经、睡眠、心理状况、糖尿病史、高血压史、心血管病史、血尿素氮、血肌酐、血红蛋白、血尿酸、透析史及透析频次,通过单因素及多因素Logistic回归分析判断以上各项是否为围绝经期维持性血液透析患者认知功能的影响因素。结果138例围绝经期维持性血液透析患者MoCA均分为(24.0±3.1)分,认知功能障碍79例,认知功能正常59例。认知功能障碍患者的MoCA总分,执行功能、命名、记忆、注意力、抽象及延迟回忆维度评分均显著低于认知功能正常者,差异均有统计学意义(均P<0.05);但语言和定向力维度评分比较,差异均无统计学意义(均P>0.05)。单因素分析结果显示,年龄51~60岁、受教育年限≤12年、睡眠质量差、心理状况不良、有糖尿病史、血肌酐<1000μmol/L、血红蛋白<110 g/L、血尿酸<150μmol/L及透析史≥36个月的围绝经期维持性血液透析患者认知功能障碍发生率更高,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,年龄、受教育年限、睡眠、心理状况、糖尿病史、血肌酐、血尿酸及透析史是围绝经期维持性血液透析患者认知功能障碍发生的影响因素,差异均有统计学意义(均P<0.05)。结论围绝经期维持性血液透析患者多存在一定程度的认知功能障碍,表现为执行功能、命名、记忆、注意力、抽象及延迟回忆能力下降,其受到年龄、受教育年限、睡眠、心理状况、糖尿病史、血肌酐、血尿酸及透析史等因素影响,需要积极采取针对性干预措施,改善患者的健康认知状况。

Analysis on change characteristics and influencing factors of cognitive function in perimenopausal patients treated by maintenance hemodialysis

Objective To analyze change characteristics and influencing factors of cognitive function in perimenopausal patients treated by maintenance hemodialysis,provide a reference basis for improving health cognitive status of these patients.Methods From December 2018 to November 2020,138 perimenopausal patients treated by maintenance hemodialysis in Taizhou Hospital of Zhejiang Province were selected as study object,Montreal Cognitive Assessment(MoCA)(Chinese version)was used to evaluate cognitive function and analyze the change characteristics,the data of patients were collected by medical records and survey questionnaire,including age,education years,menstruation,sleep,psychological status,medical history of diabetes,hypertension,cardiovascular diseases,blood urea nitrogen,creatinine,hemoglobin,uric acid,history and frequency of hemodialysis.Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of cognitive function.Results The average score of MoCA scale was(24.0±3.1),79 patients were found with cognitive dysfunction,and 59 patients were found with normal cognitive function.The total score of MoCA scale,the scores of executive function dimension,naming dimension,memory dimension,attention dimension,abstraction dimension,and delayed memory dimension in patients with cognitive dysfunction were statistically significantly lower than those in patients with normal cognitive function(P<0.05),there was no statistically significant difference in the scores of language dimension and directive force dimension between the two groups(P>0.05).Univariate analysis showed that the incidence rate of cognitive dysfunction were higher in perimenopausal patients aged 51-60 years old,education years≤12 years,poor sleep quality,poor psychological condition,medical history of diabetes,blood creatinine<1000μmol/L,hemoglobin<110 g/L,uric acid<150μmol/L,and history of hemodialysis≥36 months(P<0.05).Multivariate Logistic regression analysis showed that age,education years,sleep,psychological status,medical history of diabetes,blood creatinine,uric acid,and history of hemodialysis were influencing factors of cognitive dysfunction in perimenopausal patients treated by maintenance hemodialysis(P<0.05).Conclusion Cognitive dysfunction is observed in perimenopausal patients treated by maintenance hemodialysis to a certain extent,the main performances include decrease of executive function,naming,memory,attention,abstraction,and delayed memory,which are affected by age,education years,sleep,psychological status,medical history of diabetes,blood creatinine,uric acid,and history of hemodialysis,corresponding intervention measures should be taken to improve cognitive function of these patients.