慢性心力衰竭的认知障碍流行病学研究进展

反映学习和记忆的认知功能是大脑高级神经活动的表现,认知障碍是由于某些疾病等原因导致认知功能(学习和记忆等神经行为学)出现损伤的表现.     

慢性心力衰竭病人认知障碍特点及评价方法

临床中,慢性心力衰竭病人存在不同程度的认知功能障碍,以轻微认知功能障碍为特征,临床评价较困难。若不进行有效干预,后期可发展为阿尔茨海默病或血管性痴呆,因此,早期发现并进行有效防治具有重要临床意义。现回顾慢性心力衰竭认知功能病人的流行病学资料,对慢性心力衰竭病人认知功能损害特征进行描述,主要表现为执行功能受损,同时比较不同评价量表在心力衰竭病人认知障碍中的应用特点。     

老年慢性心力衰竭与认知功能障碍的相关性分析

目的探讨老年慢性心力衰竭（CHF）与认知功能障碍的关系。方法 采用蒙特利尔认知评估量表（MoCA）对55例CHF患者（CHF组）、50例非CHF患者（对照组）进行认知评定,分析认知功能的差异及特点。结果CHF组认知障碍发生率（69．1％）高于对照组（46．0％）,2组比较,差异有统计学意义（P〈O．05）。与对照组比较,CHF组认知总分明显降低（P〈0．05）,各认知领域均出现不同程度下降,其中视空间与执行功能、注意与计算力、语言、延迟记忆方面评分降低明显,与对照组比较,差异有统计学意义（P〈O．05或P〈0．01）。结论老年CHF是加重认知功能障碍的重要因素。     

慢性心力衰竭患者认知障碍及影响因素的研究进展

正慢性心力衰竭(chronic heart failure,CHF)亦称慢性充血性心力衰竭,是由于心脏器质性或功能性疾病损害心室充盈和射血能力,导致机体出现相关症状和体征的一组临床综合征;其主要临床表现为呼吸困难和乏力(活动耐量受限),以及液体潴留(肺淤血和外周水肿)~([1])。作为各种心脏疾病的终末阶段,CHF已成为当前最主要的心血管疾病之一,其发病率呈持续增长的趋势~([2])。认知障碍泛指各种原因导致     

老年慢性心力衰竭患者临床特点

【】: 目的 分析老年慢性心力衰竭患者的临床特征。方法 选择2010年7月至2014年12月确诊的老年慢性心衰住院患者78例,根据年龄分为普通老年组和高龄老年组,收集患者一般资料、入院后检查结果及药物治疗情况,包括：年龄、有无心衰相关性疾病(高血压、糖尿病、冠心病、肾功能不全),入院时心率、血压,入院后血肌酐、电解质、胸片有无肺淤血、超声心动图指标)、住院期间血浆BNP(Brain Natriuretic Peptide)水平变化以及药物治疗情况(主要指β- 受体阻滞剂,ACEI 或者ARB,强心剂、利尿剂等)。住院期间给予标准化抗心衰治疗并在出院前评估心功能,检测血浆BNP水平。结果 普通老年患者抗心衰治疗后心功能分级心功能Ⅰ Ⅱ级为26 %,心功能Ⅲ级为63%,心功能Ⅳ级为11%,而高龄老年患者 则分别为21%、60%和19%;出院时BNP水平分别为267.7±106.2(pg/mL)和401.5±98.9(pg/mL) 结论 高龄老年患者抗心衰治疗后心功能分级及BNP水平高于普通老年患者。     

小剂量倍他乐克治疗老年慢性心力衰竭的临床观察

目的：探讨小剂量倍他乐克治疗老年人慢性心力衰竭的疗效,方法：85例65岁以上老年慢性心力衰竭患,在强心,利尿,扩血管药物治疗的基础上加用小剂量倍他乐克治疗,初始口服倍他乐克6．25mg,每日1－2次,依耐受程度每周加量1次,直至达12．5－25mg ,每日1－2次,维持治疗,疗程3个月,结果：总有效率94．1％,显效率41．2％,无明显副作用,结论：他乐克治疗老年慢性心力衰竭患安全,有效。     

老年慢性心力衰竭患者的综合护理干预

老年慢性心力衰竭（chronic heart failure，CFH）是各种心血管疾病终末阶段的临床表现，预后不良。我科2007年-2009年共收治了90例老年慢性心力衰竭患者，采取包括预见性护理、心理护理及适度运动康复在内的综合护理措施，以达到改善心功能和提高生活质量的目的，现将护理体会报告如下。     

老年慢性心力衰竭患者临床特点分析

目的了解老年慢性心力衰竭(CHF)患者的心力衰竭病因、药物治疗及死亡原因构成情况。方法入选大连市中心医院2002年1月1日至2009年12月31日确诊的老年慢性心力衰竭住院患者518例,对入选患者病因、药物治疗及死亡方式情况进行统计分析。结果老年患者占同期慢性心力衰竭住院患者69.6%。男女比例为1.67:1。入院时(NYHA)心功能分级Ⅲ级(58.6%)和Ⅳ级(28.5%)患者居多。CHF病因构成由高至低依次为冠心病(63.7%),高心病(17.14%),风心病(8.5%)、扩心病(6.2%)。抗心衰药物使用率由高到低分别为:硝酸酯类(86.5%)、利尿剂(74.4%)、洋地黄类(58.6%)、血管紧张素转换酶抑制剂(45.2%),β受体阻滞剂(22.3%)和醛固酮受体拮抗剂螺内酯(20.8%)。死亡原因主要为泵衰竭(52.6%)。结论老年慢性心力衰竭住院患者首位病因为冠心病,硝酸酯类、利尿剂和洋地黄类仍为主要治疗药物,ACEI、β受体阻滞剂在基层医院应用仍不普遍。     

老年慢性心力衰竭患者甲状腺素水平降低的临床意义

慢性心力衰竭(CHF)是各种病因所引起的多种心脏病的终末期临床表现,是一种复杂的临床综合征,常伴有一系列神经内分泌及代谢紊乱,其中甲状腺激素(TH)的变化近年来备受关注,TH对心肌代谢,心肌收缩功能起重要作用[1]。本研究旨在探讨CHF时TH水平变化及与老年CHF患者心功能损害程度     

心力衰竭相关认知障碍的研究进展

心力衰竭(HF)是由于任何心脏结构或功能异常导致心室充盈或射血功能受损的一组复杂的临床综合征,可通过不同机制影响到包括大脑在内的多种器官功能。近年来,在HF疾病的研究中"心-脑双向交互作用"逐渐受到重视,其中HF相关的认知障碍(CI)得到临床极大关注。尽管已有研究提示HF患者合并CI可明显增加再入院及死亡的风险,但在现有的临床实践中,并不常规对HF患者进行CI筛查,易出现漏诊,从而影响患者预后。因此,本文对近期HF相关CI病理生理机制的临床研究及筛选方法、治疗等方面的新进展进行综述,以期提高临床工作者对该问题的认识。     

老老年高血压伴慢性心力衰竭患者心功能分级与血红蛋白相关性分析

目的研究老老年原发性高血压伴慢性心力衰竭患者,不同心功能分级之间血红蛋白差异,及两者之间的相关性。方法选取2013年1月—2014年2月广安门医院心内科住院的老老年高血压患者203例,根据纽约心功能分级标准将患者分成心功能Ⅰ级69例,Ⅱ级59例,Ⅲ级52例,Ⅳ级23例,比较各组间血红蛋白的数值。结果各组老老年高血压患者血红蛋白,心功能Ⅳ级组(114.52 g/L±16.18 g/L)心功能Ⅲ级组(122.61 g/L±16.45 g/L)心功能Ⅱ级组(126.33 g/L±14.88 g/L)心功能Ⅰ级组(129.13 g/L±14.40 g/L);将心功能分级与血红蛋白量行Spearman相关性分析显示,两者之间存在显著负相关(r=-0.239,P=0.001)。结论在老老年原发性高血压患者中,不同心功能分级与血红蛋白的关系密切,应注重该指标监测,合理进行临床干预,有利于患者心功能改善,预防心功能进一步恶化,改善老老年高血压患者的生活质量及预后。     

老年慢性充血性心力衰竭患者血浆脑钠肽、胱抑素C水平和心功能的变化

目的观察老年慢性充血性心力衰竭(CHF)患者脑钠肽(BNP)和胱抑素C(Cys-C)水平与心功能的变化。方法随机选择63例老年CHF患者,对不同心功能分级的老年慢性CHF患者血浆BNP、Cys-C水平与左室舒张末期内径(LVD)、左室收缩末期内径(LVS)、左室射血分数(LVEF)、心输出量(CO)进行检测。结果心功能分级Ⅰ级~Ⅵ级的老年慢性CHF患者,血浆BNP和Cys-C水平与LVD和LVS值逐渐升高,LVEF和CO值则逐渐下降,NYHA心功能Ⅰ级~Ⅵ级患者血浆BNP、Cys-C水平、LVD、LVS、LVEF和CO值比较,差异均有统计学意义(P0.05)。结论老年慢性CHF患者血浆BNP和Cys-C水平变化与心功能密切相关,可作为心功能评价和治疗疗效及预后判断的敏感指标,具有较高的临床价值。     

Mild Cognitive Impairment,Screening, and Patient Perceptions in Heart Failure Patients

ObjectiveCognitive impairments are prevalent in heart failure (HF) patients, worsening outcomes but often undetected.The aim of this study was to screen HF outpatients for mild cognitive impairment (MCI), determine the areas of cognition affected, patient awareness of cognitive change, and associated factors.Method and ResultsHF patients (n = 128) newly registered for the Management of Cardiac Function program, free from neurocognitive disorder, and with sufficient visual acuity were assessed with the use of the Montreal Cognitive Assessment tool (MoCA). MCI was classified as MoCA score ≤22. The sample was elderly (mean, 80.65 years; SD, 11.52). Mean MoCA score was 24.58 (SD 3.45), 22% were classified as impaired, 45% had noticed a change in cognition, and 15% reported that they were affected in their daily lives. Patients noticing this impact had lower MoCA scores (22.74, SD 3.0) than those who did not (25.17, SD 2.96; P ≤ .02). Most impairments occurred for delayed recall, visuospatial/executive function, and abstraction. The odds of impairment increased by the presence of ischemic heart disease (odds ratio, 4.18; 95% confidence interval, 1.15–15.69).ConclusionsIn HF outpatients without a dementia diagnosis, MCI is prevalent. Screening for MCI and incorporation of compensatory strategies are essential.     

慢性脑缺血与认知功能障碍

慢性脑缺血是一种常见的病理状态,伴发于多种脑血管病的病理过程中。许多临床和实验室证据都表明,慢性脑缺血能引起认知功能障碍。目前的研究认为,慢性脑缺血能够引起能量代谢障碍、葡萄糖利用减少、蛋白质合成异常、神经递质改变、胆碱能受体缺失、脑白质损害和神经元缺陷等,构成了导致认知功能损害的病理生理基础:     

Relationship between the Thyroid Function and Cognitive Impairment in the Elderly in Japan

Objective The reference ranges of serum thyroid hormone levels are determined by the values of normal subjects aged 15 or 20 to 60 years old in Japan and may differ from the values in elderly patients. In addition, the relationship between the thyroid function and cognitive function remains controversial. We assessed the thyroid function of elderly subjects ≥60 years old and its impact on the cognitive function in Japanese adults. Methods We compared the thyroid function by age group and gender and investigated the effects of cognitive impairment on the thyroid function. This study was a cross-sectional, multi-institutional joint study. Patients The serum concentrations of thyroid hormones in 1,136 patients were measured; however, those taking thyroid hormones, anti-thyroid drugs, and steroid hormones were excluded. Among them, 1,016 cases in which the cognitive function was evaluated were divided into five groups according to their free thyroxine (FT4) levels. Results Excluding overt thyroid dysfunction (5.8%), the average age of the 1,070 remaining patients was 77.5 years old. The rate of cognitive impairment was lowest at FT4 levels of 1.1-1.2 ng/dL and highest at FT4 levels ＜0.9 ng/dL for both genders. Thyroid-stimulating hormone (TSH) levels in the elderly varied widely by age group and gender. The upper limit of the reference range of TSH for those ≥60 years old may be higher (7.7-9.2 mIU/L for men; 8.2-8.6 mIU/L for women) than the current range for those ＜60 years old (4.23 mIU/L). Conclusion The thyroid function seemed to be slightly higher (lower TSH and higher FT4) in the population without cognitive impairment than in those with cognitive impairment, except for men in their 90s.     

抑郁对慢性心力衰竭患者的影响

慢性心力衰竭患者常伴有抑郁,而抑郁又对慢性心力衰竭的发生和发展产生影响,现就抑郁对慢性心力衰竭患者的临床影响、发生机制及相关治疗做一综述。     

老年人多种性激素活性的相互调控作用与认知功能障碍

目的:探讨老年人多种性激素活性变化相互调控作用与认知功能障碍的关系。方法:用简易智力状态检查(MMSE)对216例60岁以上入选样本进行认知功能检查。按MMSE评分将样本分为2组,即认知功能正常组和认知功能障碍组;采用放射免疫学方法,测定入选样本血清泌乳素、雌二醇、睾酮、孕酮、卵泡刺激素和黄体生成素等性激素水平,比较同性别中认知功能正常组和认知功能障碍组性激素水平变化。结果:同性别中认知功能障碍组中的泌乳素、雌二醇和睾酮水平较认知功能正常组低(P<0.05)。结论:认知功能下降可能与雌二醇、睾酮和泌乳素水平降低有关。认知功能与多种性激素的活性变化及其之间的相互调控抗衡存在着密切关系,并非单一因素所能概括。     

Progression of Renal Impairment and Chronic Kidney Disease in Chronic Heart Failure: An Analysis From GISSI-HF

Background

Data on the natural change in renal function in patients with chronic heart failure (HF) are limited.

Diastolic Heart Failure in the Elderly

It is now clear that diastolic heart failure (DHF) is an important, perhaps even dominant form of heart failure in older Americans. However, our knowledge base regarding the epidemiology, pathophysiology, natural history, and therapy of this relatively recently recognized disorder is limited. A number of normal age related changes in the heart and vascular system may predispose to or lower the threshold for expression of DHF. Recent reports from large population-based observational studies indicate that over 50% of persons 65 years and older who have heart failure have normal LV systolic function (presumed DHF). Among these, 45% have no other confounding variables (coronary, valvular, or pulmonary disease) and meet the criteria for isolated DHF. DHF is substantially more common in older women than men. A history of systemic hypertension and left ventricular hypertrophy are almost invariably present. Mortality rates are about 50% lower in DHF than in systolic heart failure (SHF) when stable outpatients are considered. However, in hospitalized and very elderly patients, the mortality rate appears similar in DHF and SHF. Furthermore, due to its higher prevalence, the total mortality in the older population attributable to DHF exceeds that of SHF. Morbidity in DHF is substantial and approaches that of SHF.In the chronic setting, DHF patients can have severe exercise intolerance related to failure of the Frank-Starling mechanism with reduced peak cardiac output, heart rate, and stroke volume and increased LV filling pressure. DHF patients also appear to have increased vascular stiffness, accelerated systolic blood pressure response to exercise, neuroendocrine activation, and reduced quality of life. Acute exacerbations (pulmonary edema) frequently occur and are associated with severe hypertension, sodium indiscretion, and medication non-compliance. Surprisingly, overt myocardial ischemia appears to infrequently play a role in these acute exacerbations.Therapy is currently empiric and multicenter, randomized, controlled trials are urgently needed. Anecdotally, control of blood pressure appears to improve symptoms and reduce the frequency of acute exacerbations. In addition, non-pharmacologic intervention, including multi-disciplinary case management is useful.