李耀,邢红云,罗梅

• 1:上海市浦东新区人民医院心内科
• 2:新疆医科大学第五附属医院心内科

摘要(Abstract)：

目的比较双腔心脏起搏器植入前后认知功能的变化情况,探讨可能影响认知功能的独立危险因素。方法收集新疆医科大学第五附属医院2014年12月-2017年3月住院的缓慢性心律失常患者和同期体检者各60例。采用简易精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评估两组认知功能,MoCA量表再次评估双腔起搏器植入术后3个月认知功能。分析治疗前后变化和影响MoCA量表得分的因素。结果 MMSE、MoCA量表评估病例组与对照组各认知功能亚项评分及总分差异均有统计学意义(P<0.01),病例组术前与术后3个月MoCA评估各认知功能亚项及总分比较,除注意、抽象和定向3个亚项外,其他差异具有统计学意义(P<0.05)。年龄和MoCA总分具有相关性(P<0.001),且呈负相关。文化程度和年龄为MOCA评分的独立影响因素,差异有统计学意义(P<0.05)。结论双腔心脏起搏器植入术能改善缓慢性心律失常患者部分认知功能。影响认知功能的因素为年龄、文化程度和主要心脑血管疾病(冠心病、高血压、糖尿病),年龄、文化程度为影响认知功能的独立危险因素。

关键词(KeyWords)： 心脏起搏器;缓慢性心律失常;认知功能;MMSE量表;MoCA量表

Abstract:

Keywords:

基金项目(Foundation): 新疆维吾尔自治区自然科学基金(2017D01C274)

作者(Author): 李耀,邢红云,罗梅

参考文献(References)：

• [1] GOPINATHANNAIR R,ETHERIDGE S P,MARCHLINSKI F E,et al.Arrhythmia-induced cardiomyopathies:cechanisms,recognition,and management[J].J Am Coll Cardiol,2015,66(15):1714-1728.
• [2] WANG H T,LIU WH,CHEN Y L.Transient sick sinus syndrome with complete atrioventricular block associated with ergonovine intake:A case report[J].Medicine,2017,96(44):e8559.
• [3] TANG H,GAO Y,ZHANG Q,et al.Chronic cerebral hypoperfusion independently exacerbates cognitive impairment within the pathopoiesis of Parkinson′s disease via microvascular pathologys[J].Behav Brain Res,2017,333:286-294.
• [4] FORLENZA O V,DINIZ B S,RADANOVIC M,et al.Disease-modifying properties of long-term lithium treatment for amnestic mild cognitive impairment:randomised controlled trial[J].Br J Psychiatry,2018,198(5):351-356.
• [5] FOWLER N R,JOHNSON K G,LI J,et al.use of cardiac implantable electronic devices in older with cognitive impairment[J].JAMA Intern Med,2014 ,174(9):1514-1516.
• [6] JIN K P,PARK J,MUN H S,et al.Abstract 11482:combined algorithm using a poor increase in inferior P-wave amplitude during sympathetic stimulation and conventional csnrt as a diagnostic method for sick sinus syndrome[J].Circulation,2014,130:A11482-A11482.
• [7] 黄凯荣.双腔心脏起搏器对缓慢性心律失常患者心功能的影响[J].系统医学,2018,3(14):34-36.
• [8] JAMA A,RABINSTEIN A,HODGE D,et al.cardiac device complications in the cognitively impaired[J].Electrophysiol,2013,36(9):1061-1067.
• [9] 杨磊,于富敏.MMSE与MoCA量表在认知功能筛查中的对比研究[J].临床医药文献杂志:电子版,2015,4(16):3252-3252.
• [10] PETERSEN RC,ROBERTS RO,KNOPMAN DS,et al.Prevalence of mild cognitive impairment is higher in men.The Mayo Clinic Study of Aging[J].Neurology,2010,75(10):889-897.
• [11] MORONE NE,ABEBE KZ,MORROW LA,et al.Pain and decreased cognitive function negatively impact physical functioning in older adults with knee osteoarthritis[J].Pain Medicine,2015,15(9):1481-1487.
• [12] VOGELS RL,VAN DER FLIER WM,VAN HARTEN B,et a1.Brain magnetie resonance imaging abnormalities in patients with heart failure[J].Eur J Heart Fail,2007,9(10):1003-1009.
• [13] 公维军.慢性脑低灌注与认知功能障碍的关系[J].中华老年心脑血管病杂志,2017,19(12):1333-1335.
• [14] ZIMNY A,BLADOWSKA J,MACIOSZEK A,et a1.Evaluation of the posterior cingulate region with FDG-PET and advanced MR techniques in patients with amnestic mild cognitive impairment:comparison of the methods[J].J Alzheimers Dis,2015,44(1):329-338.
• [15] GOTTESMAN RF,GREGA MA,BAILEY MM,et al.Association between hypotension,low ejection fraction and cognitive per formance in cardiae patients[J].Behav Neurol,2010,22(1-2):63-71.
• [16] RASQUIN S M C,VETHEY F R J,OOSTENBRUGGE R J,et al.Demographic and CT scan features to cognitive impairment in the first yea after stroke[J].J Neurol Neurosurg Psychiatry,2014,75(11):1562-1567.
• [17] RAVAGLIA G,FORTI P,MAIOLI F,et al.Conversion of mild cognitive impairment to dementia:predictive role of mild cognitive impairment subtypes and vascular risk factors[J].Dement Geriatr Cogn Disord,2013,21(1):51-58.
• [18] 徐薇,沈岳飞,李兰晴,等.两种量表在血管性认知功能障碍评估中的应用研究[J].陕西医学杂志,2017,46(3):323-324.
• [19] 赵连生,王英成,韦锦学,等.性别、年龄、教育年限及多巴胺受体4基因多态性与成人认知功能的关联研究[J].中华医学遗传学杂志,2015,32(3):391-394.
• [20] 姜玲,朱昀,张福春.综合医院老年患者认知功能障碍及其影响因素分析[J].中华老年医学杂志,2017,36(10):1092-1096.