2018 年第 9 期 第 13 卷

慢性心力衰竭患者认知障碍的研究进展

Research progress of cognitive impairment in chronic heart failure

作者：汤辉邢绣荣李俊芬王晶

英文作者：

单位：100053北京，首都医科大学宣武医院急诊科

英文单位：

关键词：慢性心力衰竭；认知障碍；病因机制；流行病学；影响因素

英文关键词：

• 摘要：

• 【摘要】心力衰竭患者急性期的谵妄以及慢性期的记忆力、执行功能下降等认知障碍逐渐受到临床的关注。心力衰竭患者认知障碍普遍存在，且心力衰竭伴随的认知障碍与再住院率、死亡率以及医疗花费增高等不良结果有关。心力衰竭作为心血管系统疾病的终末期，所引起的认知障碍既往认为与已知的冠状动脉粥样硬化性心脏病、高血压、糖尿病、高脂血症等心血管疾病和危险因素有关，是通往血管性痴呆的中间阶段。研究表明心力衰竭已成为引起认知障碍的独立危险因素，其发病机制可能与脑灌注不足、脑微血栓形成、心输出量下降等有关。心力衰竭认知障碍可能是多种因素共同作用的结果。目前常用对心力衰竭患者认知障碍的筛查工具有神经科简易智力状态检查量表和蒙特利尔认知评估量表，指南还没有推荐哪种筛查手段更适合应用于心力衰竭患者。对伴随轻度认知障碍的心力衰竭患者的研究提示通过治疗干预可使认知功能得到改善。这也为出院患者的后续治疗随访以及心力衰竭患者的自我管理提供了更多的建议和支持手段。

• 【Abstract】In acute heart failure patients, delirium and cognitive impairment including chronic memory loss, attention and executive function reduction have raised clinical attentions. Heart failure with cognitive impairment is associated with readmission, high medical costs and mortality. Cognitive impairment caused by heart failure is related to conventional cardiovascular risk factors such as coronary heart disease, hypertension, diabetes and hyperlipemia. Heart failure is an independent risk factor of cognitive impairment; coexisted mechanisms such as cerebral hypoperfusion, microthrombosis and low cardiac output are involved. Common assessment means include Mini-Mental State Examination and Montreal Cognitive Assessment; there are no authoritative guidelines recommending the most appropriate and effective scales. Some studies have proved that cognitive impairment could be reversible; effective prevention measures may support subsequent treatments and self-management procedure in heart failure patients.