慢性肾功能衰竭肾衰竭期患者认知功能的研究
|
摘要
慢性肾功能衰竭是各种慢性肾脏疾病持续进行性发展的最终结局。肾功能严重减退时，代谢废物潴留，水电解质平衡紊乱，以至于不能维持机体内环境的稳定，严重影响患者的认知功能。认知(cognition)包括感觉、知觉、记忆、思维、判断、推理、语言等。慢性肾功能衰竭时，患者出现注意力不集中、表情淡漠或易机动、易怒、记忆力减退、警觉能力下降、定向力减退、反应较迟钝、思考缓慢，工作效率低等症状。并随肾功能减退而加重。重症者可出现精神错乱、幻觉、幻听、幻视和妄想。认知功能的下降不但可以影响患者的情绪，免疫功能、营养状态及治疗的配合性，甚至可以影响患者的预后。
目的：本研究旨在探讨慢性肾功能衰竭(肾衰竭期)患者的认知功能的变化、不同治疗方法对其认知功能的影响，以及影响慢性肾功能衰竭(肾衰竭期)患者认知功能的相关因素，并初步探讨临床上如何最大程度上改善患者的认知功能。
方法：本课题采用字母化消测验及连续相加测验。
字母划消测验(Letter Callcel Test,LCT)：划消测验是常用的检查注意力集中能力的一种心理测验。随着作业时间延长可以反映被测试者注意的持久性。它的优点是使用方便，便于进行群体测
第四军医大学硕士学位论文
验。
测验要求被测试者按顺序搜索和标识(从左到右，从上到下)，
目标字母C、G、N，干扰字母为除“O”以外22个字母，要尽可
能的迅速和准确。字母用Times New Roman，字体12号字打印。
在A4的纸上每行”个字母，其中包括9个刺激字母(C、G、N
各3个)和44个干扰字母。每行字母进行随机排列，每页共40
行，测验时间5分钟。
观察指标:5分钟正确划消字母数、字母划消正确率。
连续相加测验(continuous Caleulation Test，CCT)。数字的连续
计算是较复杂的认知测验，连续相加测验主要用于评估被试的短
时记忆、思维和计算的综合能力。
测验要求被测试者将测验表中的横列数字连续累计相加，
如果得到的是两位数，只记个位数，十位数不记，直至完成20道
题的任务。要求在保证正确的情况下快速完成。
观察指标测试完成时间(单位:秒)和错误率。
本课题共分为三部分:
1、将慢性肾功能衰竭(肾衰竭期)患者30例(男20例，女
10例)与正常对照进行研究。病例入组标准为:按照内科学第五
版慢性肾衰竭(肾衰蝎期)诊断标准:Cr:450一707umollL，BUN:
>20mmol/l， GFR:10一15ml/m in.临床上出现尿毒症脑病如嗜睡、
记忆力减退等，感觉运动神经病变如“不安腿综合征”，感觉迟钝
等，食欲减退伴恶心，贫血，利尿剂无效的水肿等症状，病史巧
年而选取慢性肾功能衰竭肾衰竭期患者50例。对其进行以下筛选:
排除脑血管病史(包括出、缺血性脑血管病)，神经系统检查无偏
瘫、身体感觉障碍失语等中枢神经损害病史如肿瘤、感染、CO中
毒，中枢神经脱妞鞘疾病，患者自愿参加测试。结果38例符合标
准。再根据其拟接受的三种治疗方案中各选取10例，共计30例
患者作为本实验的病例组。其中男20例，女10例。年龄为25一60
第四军医大学硕士学位论文
岁，平均年龄40.5士5 .4岁。平均受教育年限9.80土6.41年。患者
的化验指标为:Cr:539.27士1 16.7 umol/L，BUN:23.29士
6·63mmol/L，Hb:77.6士1 1 .79似l。对照组:30例(男18例，女12
例)，来源于体检中健康人群。年龄为26一62岁，平均年龄42.7.5
士4.8岁。平均受教育年限10.90土5.18年。
病例组和对照组年龄、受教育年限经独立样本T检验，P值分
别为0.536，0.37(P>0.05)，两组无统计学差异。两组性别经xZ
检验P>0.05，无统计学差异。两组分别接受测试。
2、将以上30例患者作为研究对象，分组治疗方案具体为:
内科保守治疗(组1):低蛋白或低磷饮食，成人每日蛋白质摄入
量为。.69/kg左右.蛋白质要以含有人体必需氨基酸的动物蛋白为
主。控制各种感染、腹泻、呕吐、电解质和酸碱平衡紊乱。控制
血压、调节血脂等治疗。血液透析治疗(组2):每周血透2一3次，
每次4一4.5小时、血液透析+促红素(组3)治疗每周血透2一3
次，每次4一4.5小时，促红素每周2一3次，于每次透析结束后皮
下注射。以上方案的疗程均为3个月，治疗前后分别接受侧试。
3、对每名慢性肾功能衰竭(肾衰竭期)患者均详细收集关于
其年龄、教育年限、血压、血肌醉、尿素氮、血红蛋白、低密度
脂蛋白、高密度脂蛋白、胆固醉等资料。其中，血肌醉、尿素氮、
血红蛋白、均在患者人院时及入院期间进行化验检查，血压、血
脂等资料均是经过多次或两次测盘后的平均值，以减少单次采样
所带来的误差，采用多元回归，分析影响慢性肾功能衰竭(肾衰
竭期)患者认知功能的因素。
结果:
1、慢性肾功能衰竭(肾衰竭期)患者字母划消测试与对照组
在存在显著性差异(P<0 .05)，提示前组的注意力、集中能力明显
低于后组。
2、慢性肾功能衰蝎(肾衰竭期)患者连续相加测试与对照组
第四军医大学硕士学位论文
在存在显著性差异(P<0.05)，提示前组短时记忆、思维和计算的
综合能力明显低于后组。
3、内科保守治疗前后患者字母化消测试及连续相加测试无差
异(P>O，05
Cognition includes sense, consciousness, memory, thinking, judgement, reasoning, language, ect. Renal failure is final ending of continuous development of chronic renal disease .renal function decrease, metabolite retntion, Water-electrolyte balance, which can not maintain internal environment stabilization of body and influence patients' cognitive function severely.
Such as Inattention expression Indifference , agitation ,rage , anamnesis decrement, alertness decline , orientation decrement, response and thinking slowing, work efficiency decrease, can be seen in these patients. With renal function declining ,Syndrome becoming worse and worse .mental disorder , hallucination, akoasm, visual hallucination, delusioncan be seen in severe patients. Decline of cognitive function can influence patients' emotion , immunological function, nutrition behavior and fit of therapy. Moreover ,it also influence patients' prognosio
Aim : study mainly discuss change of cognitive function of patients with chronic renal function failure (early uremia), different influence of cure methods for patients with chronic renal function failure(early uremia) and during the therapy ,relation among level of ferrohemoglobin , creatinine ,Urea nitrogen and cognitive function. In the end ,we will discuss how to improve patients' cognitive function . Method: the study use LCT (letter cancel test) and CCT ( Continuous Calculation Test).
Cancellation tests have a long history in attention assessment. With the time going , It can reflect persistence of attention. Its use is very easy. Test request :Most commonly, they are administered as paper-and-pencil tests that are normally used to assess a person's ability to visually search for an identifiable target and to either cancel or circle all such target items in an array such as the 'C ,'G' ,'N'. They vary widely in their complexity from long letter strings, Every array has 53 letters which include 9 stimulating letters and 44 interferential letters. Letters in ever array are arrayed randomly. Every page has 40 lines .Test time is 5 minute. In the study , patients select correctness thus right rate can keep high level. Observation marker: the number of right canceled letters, right rate of letter.
Continuous Calculation Test, CCT it is complex cognitive test. This test mainly be used in assessing patient's mixed ability of short memory, thinking , arithmetic. Test request patient must add the number continuously, if the number is two digits ,only write 个位,till finished 20 subject.
This paper comprises three parts :
1. A case control study was carried out , based on 30 patients with chronic renal failure (early uremia) and 30 matched healthy people .The case entering standard :adults ,aged from 30-50 . Cr: 539.27+ 116.7 umol/L, BUN: 23.29 +6.63mmol/L, Hb:77.6+ 11.7g/dlo Without consciousness disorder , aphasia, obvious sight disorder, without such disease as hypertension and diabetes and so on .The results of CT and MRI showed that there are obvious localizations and confirmed by surgery . The patients are cooperative and have not apparent headache When the test are being performed ,the age ,sex, and literacy level of the control groups are matched with those of cases.
2. we divide chronic renal failure patients to 3 group randomly .every group involves 10 patients. We give every group therapy respectively: conservative medicine therapy (group 1).low protein diet or low phosphorum diet. Adult must intake0.6g/kg protein. To control various kinds infection , Diarrhoea, emesis, electrolure and Disturbance of acid-base balance. To control blood pressure, decrease blood fatty acid. Hemodialysis(group 2) 3 times every week.4 - 4.5h/time Hemodialysis +EPO (group3) Hemodialysis (group 2) 3 times every week. 4 -4.5h/time .EPO Subcutaneous injection two times a week after hemodialysis . Therapy time is 3 monthes .The patients received test before and after therapy. 3. At the same time analyze the interrelationship between cognitive scale of patients with chronic renal function failure and relat
目的：本研究旨在探讨慢性肾功能衰竭(肾衰竭期)患者的认知功能的变化、不同治疗方法对其认知功能的影响，以及影响慢性肾功能衰竭(肾衰竭期)患者认知功能的相关因素，并初步探讨临床上如何最大程度上改善患者的认知功能。
方法：本课题采用字母化消测验及连续相加测验。
字母划消测验(Letter Callcel Test,LCT)：划消测验是常用的检查注意力集中能力的一种心理测验。随着作业时间延长可以反映被测试者注意的持久性。它的优点是使用方便，便于进行群体测
第四军医大学硕士学位论文
验。
测验要求被测试者按顺序搜索和标识(从左到右，从上到下)，
目标字母C、G、N，干扰字母为除“O”以外22个字母，要尽可
能的迅速和准确。字母用Times New Roman，字体12号字打印。
在A4的纸上每行”个字母，其中包括9个刺激字母(C、G、N
各3个)和44个干扰字母。每行字母进行随机排列，每页共40
行，测验时间5分钟。
观察指标:5分钟正确划消字母数、字母划消正确率。
连续相加测验(continuous Caleulation Test，CCT)。数字的连续
计算是较复杂的认知测验，连续相加测验主要用于评估被试的短
时记忆、思维和计算的综合能力。
测验要求被测试者将测验表中的横列数字连续累计相加，
如果得到的是两位数，只记个位数，十位数不记，直至完成20道
题的任务。要求在保证正确的情况下快速完成。
观察指标测试完成时间(单位:秒)和错误率。
本课题共分为三部分:
1、将慢性肾功能衰竭(肾衰竭期)患者30例(男20例，女
10例)与正常对照进行研究。病例入组标准为:按照内科学第五
版慢性肾衰竭(肾衰蝎期)诊断标准:Cr:450一707umollL，BUN:
>20mmol/l， GFR:10一15ml/m in.临床上出现尿毒症脑病如嗜睡、
记忆力减退等，感觉运动神经病变如“不安腿综合征”，感觉迟钝
等，食欲减退伴恶心，贫血，利尿剂无效的水肿等症状，病史巧
年而选取慢性肾功能衰竭肾衰竭期患者50例。对其进行以下筛选:
排除脑血管病史(包括出、缺血性脑血管病)，神经系统检查无偏
瘫、身体感觉障碍失语等中枢神经损害病史如肿瘤、感染、CO中
毒，中枢神经脱妞鞘疾病，患者自愿参加测试。结果38例符合标
准。再根据其拟接受的三种治疗方案中各选取10例，共计30例
患者作为本实验的病例组。其中男20例，女10例。年龄为25一60
第四军医大学硕士学位论文
岁，平均年龄40.5士5 .4岁。平均受教育年限9.80土6.41年。患者
的化验指标为:Cr:539.27士1 16.7 umol/L，BUN:23.29士
6·63mmol/L，Hb:77.6士1 1 .79似l。对照组:30例(男18例，女12
例)，来源于体检中健康人群。年龄为26一62岁，平均年龄42.7.5
士4.8岁。平均受教育年限10.90土5.18年。
病例组和对照组年龄、受教育年限经独立样本T检验，P值分
别为0.536，0.37(P>0.05)，两组无统计学差异。两组性别经xZ
检验P>0.05，无统计学差异。两组分别接受测试。
2、将以上30例患者作为研究对象，分组治疗方案具体为:
内科保守治疗(组1):低蛋白或低磷饮食，成人每日蛋白质摄入
量为。.69/kg左右.蛋白质要以含有人体必需氨基酸的动物蛋白为
主。控制各种感染、腹泻、呕吐、电解质和酸碱平衡紊乱。控制
血压、调节血脂等治疗。血液透析治疗(组2):每周血透2一3次，
每次4一4.5小时、血液透析+促红素(组3)治疗每周血透2一3
次，每次4一4.5小时，促红素每周2一3次，于每次透析结束后皮
下注射。以上方案的疗程均为3个月，治疗前后分别接受侧试。
3、对每名慢性肾功能衰竭(肾衰竭期)患者均详细收集关于
其年龄、教育年限、血压、血肌醉、尿素氮、血红蛋白、低密度
脂蛋白、高密度脂蛋白、胆固醉等资料。其中，血肌醉、尿素氮、
血红蛋白、均在患者人院时及入院期间进行化验检查，血压、血
脂等资料均是经过多次或两次测盘后的平均值，以减少单次采样
所带来的误差，采用多元回归，分析影响慢性肾功能衰竭(肾衰
竭期)患者认知功能的因素。
结果:
1、慢性肾功能衰竭(肾衰竭期)患者字母划消测试与对照组
在存在显著性差异(P<0 .05)，提示前组的注意力、集中能力明显
低于后组。
2、慢性肾功能衰蝎(肾衰竭期)患者连续相加测试与对照组
第四军医大学硕士学位论文
在存在显著性差异(P<0.05)，提示前组短时记忆、思维和计算的
综合能力明显低于后组。
3、内科保守治疗前后患者字母化消测试及连续相加测试无差
异(P>O，05
Cognition includes sense, consciousness, memory, thinking, judgement, reasoning, language, ect. Renal failure is final ending of continuous development of chronic renal disease .renal function decrease, metabolite retntion, Water-electrolyte balance, which can not maintain internal environment stabilization of body and influence patients' cognitive function severely.
Such as Inattention expression Indifference , agitation ,rage , anamnesis decrement, alertness decline , orientation decrement, response and thinking slowing, work efficiency decrease, can be seen in these patients. With renal function declining ,Syndrome becoming worse and worse .mental disorder , hallucination, akoasm, visual hallucination, delusioncan be seen in severe patients. Decline of cognitive function can influence patients' emotion , immunological function, nutrition behavior and fit of therapy. Moreover ,it also influence patients' prognosio
Aim : study mainly discuss change of cognitive function of patients with chronic renal function failure (early uremia), different influence of cure methods for patients with chronic renal function failure(early uremia) and during the therapy ,relation among level of ferrohemoglobin , creatinine ,Urea nitrogen and cognitive function. In the end ,we will discuss how to improve patients' cognitive function . Method: the study use LCT (letter cancel test) and CCT ( Continuous Calculation Test).
Cancellation tests have a long history in attention assessment. With the time going , It can reflect persistence of attention. Its use is very easy. Test request :Most commonly, they are administered as paper-and-pencil tests that are normally used to assess a person's ability to visually search for an identifiable target and to either cancel or circle all such target items in an array such as the 'C ,'G' ,'N'. They vary widely in their complexity from long letter strings, Every array has 53 letters which include 9 stimulating letters and 44 interferential letters. Letters in ever array are arrayed randomly. Every page has 40 lines .Test time is 5 minute. In the study , patients select correctness thus right rate can keep high level. Observation marker: the number of right canceled letters, right rate of letter.
Continuous Calculation Test, CCT it is complex cognitive test. This test mainly be used in assessing patient's mixed ability of short memory, thinking , arithmetic. Test request patient must add the number continuously, if the number is two digits ,only write 个位,till finished 20 subject.
This paper comprises three parts :
1. A case control study was carried out , based on 30 patients with chronic renal failure (early uremia) and 30 matched healthy people .The case entering standard :adults ,aged from 30-50 . Cr: 539.27+ 116.7 umol/L, BUN: 23.29 +6.63mmol/L, Hb:77.6+ 11.7g/dlo Without consciousness disorder , aphasia, obvious sight disorder, without such disease as hypertension and diabetes and so on .The results of CT and MRI showed that there are obvious localizations and confirmed by surgery . The patients are cooperative and have not apparent headache When the test are being performed ,the age ,sex, and literacy level of the control groups are matched with those of cases.
2. we divide chronic renal failure patients to 3 group randomly .every group involves 10 patients. We give every group therapy respectively: conservative medicine therapy (group 1).low protein diet or low phosphorum diet. Adult must intake0.6g/kg protein. To control various kinds infection , Diarrhoea, emesis, electrolure and Disturbance of acid-base balance. To control blood pressure, decrease blood fatty acid. Hemodialysis(group 2) 3 times every week.4 - 4.5h/time Hemodialysis +EPO (group3) Hemodialysis (group 2) 3 times every week. 4 -4.5h/time .EPO Subcutaneous injection two times a week after hemodialysis . Therapy time is 3 monthes .The patients received test before and after therapy. 3. At the same time analyze the interrelationship between cognitive scale of patients with chronic renal function failure and relat
引文
[1] 李伟．认知心理学研究[M]杭州：浙江人民出版社，1998．2
[2] 张银玲．脑认知功能的研究与思考．中国行为医学科学,2002,11(1)：116-117
[3] 孙云峰，皇普恩，苗丹民等。暗示或咖啡因对健康男子30小时睡眠剥夺下简单反应时和知觉加工的影响。
[4] Vttl B,Pilkenton-Tayloy c. Letter cancellation performance across the adult life span. Clin Neuropsyshol, .2001, del; 15(4):521-30
[5] 贾强，陈秉良，孙延兵等．维持性血液透析患者心理治疗的临床研究．实用医学杂志，2002,18(7)：697-700
[6] 嵇爱琴，叶朝阳，张斌，梅长林．血液透析患者的心理状态及其相关因素分析．中华护理杂志,2001，36(7)：503-506
[7] 严冬仙，刘爱菊．血液透析病人心理状态分析．健康心理学杂志，2000,18(2):189-190
[8] Revicki DA, Brown RE, Feeny DH, Henry D, Teehan BP, Rudnick MR, Benz RL. Health-related quality of life associated with recombinant human erythropoietin therapy for predialysis chronic renal disease patients, Am J Kidney Dis. 1995 ,Apr;25(4):548-54
[9] 王捷，李红，穆素红．对影响血液透析患者生存质量心理问题的探讨．透析与人工器官,2001，12(4)：10-11
[10] 刘景芳，陆冬梅．透析病人营养与心理状况分析．社会预防与健康，2000．3(1)：56-57
[11] Ziesat HA .Jr, Logue PE, McCarty SM. Psychological measurement of memory deficits in dialysis patients. Percept Mot Skills 1980, Feb;50(1):311-8
[12] Harum P, Galvez O, Mayol LG, et al. Immediate and delayed memory recall patterns of chronic hemodialysis adult hispanic patients.J Ren Nutr.2003,Apr; 13(2):98-104
[13] 叶任高主编，内科学．北京：人民卫生出版社，2000：569-579
[14] Mendley SR, Zelko FA. Improvement in specific aspects of neurocognitive performance in children after renal transplantation, Kidney Int, 1999, Jul;56(1):318-23. ?
[15] Hulstijn-Dirkmaat GM, Damhuis IH, Jetten ML, Koster AM, Schroder CH.The cognitive development of pre-school children treated for chronic renal failure.Pediatr Nephrol, 1995, Aug;9(4):464-9
[16] France ,Mendes G. The cognitive potentials in kidney failure before and after hemodialysis. Arq. Neuro-Psiquiatr,2000,58(1): 198
[17] MacCracken MA. Anemia management practices in peritoneal dialysis patients. Case study of the anemic patient. Nephrol Nurs J. 2001,Aug;28(4):435-8. Review.
[18] D J Burn, D Bates Neurologe and the kidney. Neurol Neurosurg Psychiatry, 1998,65:810-812
[19] 肖玮，苗丹民，王京生等。内田-克莱佩林测验在民航飞行学员情绪稳定性评价中的应用。中华航空航天医学杂志，
2002，13(3)：148-151．
[20] 谢忠、黄铜等认知行为干预疗法对鼻咽癌放疗病人生存质量的影响 中国临床康复,2001，Russo LS(11)48—49
[21] 周杨，刘传新，马林青．认知行为疗法治疗功能性室性早搏28例．中国行为医学科学，1999．3(8)
[22] 赵鸿韬、龙鲸 认知行为疗法对心脏神经症患者康复治疗的作用中国临床康复2002，2(13)1896—1897
[23] 崔思松，吴正炎等．老年2型糖尿病患者认知功能的研究．老年医学杂志，1992,12(4)210—213
[24] 张银玲．脑认知功能及其哲学思考．医学与哲学,2002,23(3)：16-1844
[25] 史耀芳．语言能力的心理学研究。宁波大学学报(教育科学报)，2000 22，2：25-28
[26] 沈清瑞，叶任高，于血清等。血液净化与移植。北京：人民卫生出版社，1999：69-71
[27] Curtin RB, Klag MJ, Bultman DC, Schatell D. Renal rehabilitation and improved patient outcomes in Texas dialysis facilities. RAm J Kidney Dis. 2002 ,Aug;40(2):331-8
[28] Riley JB Jr, Pristave RJ. Patient's rights in receiving or rejecting dialysis caxe.Nephrol News Issues. 2001 ,Aug; 15(9):49-51
[29] Maier SF, Watkins LR. Immune-to-central nervous system communication and its role in modulating pain and cognition: Implications for cancer and cancer treatment. Brain Behav Immun 2003 Feb;17 Suppl 1:S125-31..
[30] 孟秀枝。49例尿毒症透析前后脑电图分析。河南医药信息，1999，7(6)：11-12
[31] John C.Stivelman. Transplantation Benefits of anaemia treatment on cognitive function. Nephrol Dial Transplant Nephrology Dialysis,2000,15[Suppl3]:29-35
[32] Eschbach, Morehouse RE, Colvin E, Maykut P. Nephrology nurse-patient relationships in the outpatient dialysis setting. Nephrol Nurs J. 2001,Jun;28(3):295-300.
[33] 李家萍。红细胞生成素治疗血液透析贫血患者给药途径的临床研究。护理学杂志，2000，15(3)：137-138
[34] Courts NF .Psychosocial adjustment of patients on home hemodialysis and their dialysis partners. Clin Nurs Res. 2000, May; 9(2):177-90
[35] Curtin RB, Klag MJ, Bultman DC, Schatell D. Renal rehabilitation and improved patient outcomes in Texas dialysis facilities. Am J Kidney Dis. 2002,Aug;40(2):331-8
[36] 王文，王汉民．应对方式和社会支持对行血液透析治疗的终末期肾病患者心理状况的影响．中国临床康复,2002,(6)9：1297-1298
[37] J Ren Nutr. Do we need a nutrition-specific quality of life questionnaire for dialysis patients? 2003, Oct;13(4):295-302., Beale G, Sandroni S, et al. Aluminium intoxication in undialysed adults with chronic renal failure. J Neurol Neurosurg Psychiatry, 1992,55(8):697-700
[38] Ziesat HA Jr, Logue PE, McCarty SM. Psychological measurement of memory deficits in dialysis patients,1980 Feb;50(1):311-8
[39] Psychol Rev. Cytokines for psychologists: implications of bidirectional immune-to-brain communication for understanding behavior, mood,and cognition.Brain Behav Immun. 1998 Jan;105(1):83-107
[40] Moss AH. Recommendations regarding conflict resolution and forgoing dialysis in special patient populations. Nephrol News Issues. 2001 ,Dec; 15 (13): 51-4.
[41] Rau-Foster M.The dialysis facility's rights, responsibilities, and duties when there is conflict with family members. Nephrol News Issues. 2001 ,Apr; 15(5): 12-4.
[42] Prolo P, Chiappelli F, Fiorucci A, Dovio A, Sartori ML, Angeli A. Psychoneuroimmunology: new avenues of research for the twenty-first century. Ann N Y Acad Sci. 2002 Jun;966:400-8. Review
[43] Morehouse RE, Colvin E, Maykut P. Nephrology nurse-patient relationships in the outpatient dialysis setting. Nephrol Nurs J. 2001,Jun;28(3):295-300.
[44] Curtin RB, Mapes DL. Health care management strategies of long-term dialysis survivors. Nephrol Nurs J.2001 Aug; 28(4): 385-92; discussion 393-4.
[45] J Am Geriatr Soc.Cytokines and cognition—the case for a
head-to-toe inflammatory paradigm. Brain Behav Immun.2002, Dec;50(12):2041-56
[46] 沈政．脑认知功能的理论框架与方法学基础[J]．北京大学学报(自然科学版)．1998,34(2-3)：401-408
[47] 魏景汉．关于汉语ERP的研究，汉语的认知研究．济南：山东人民出版社，1997
[48] 寿天德．视觉信息处理的脑机制．上海：科技教育出版社，1997：23-56
[49] PerlmuHer Lc.et al.Am Jmed 1984,77:1043
[50] Mooradian AD.etal,Arch Intern med 1988:148:2369
[51] Eschbach JW, Varma A, Stivelman JC. Is it time for a paradigm shift? Is erythropoietin deficiency still the main cause of renal anaemia? Nephrol Dial Transplant, 2002; 17 Suppl 5:2-7
[2] 张银玲．脑认知功能的研究与思考．中国行为医学科学,2002,11(1)：116-117
[3] 孙云峰，皇普恩，苗丹民等。暗示或咖啡因对健康男子30小时睡眠剥夺下简单反应时和知觉加工的影响。
[4] Vttl B,Pilkenton-Tayloy c. Letter cancellation performance across the adult life span. Clin Neuropsyshol, .2001, del; 15(4):521-30
[5] 贾强，陈秉良，孙延兵等．维持性血液透析患者心理治疗的临床研究．实用医学杂志，2002,18(7)：697-700
[6] 嵇爱琴，叶朝阳，张斌，梅长林．血液透析患者的心理状态及其相关因素分析．中华护理杂志,2001，36(7)：503-506
[7] 严冬仙，刘爱菊．血液透析病人心理状态分析．健康心理学杂志，2000,18(2):189-190
[8] Revicki DA, Brown RE, Feeny DH, Henry D, Teehan BP, Rudnick MR, Benz RL. Health-related quality of life associated with recombinant human erythropoietin therapy for predialysis chronic renal disease patients, Am J Kidney Dis. 1995 ,Apr;25(4):548-54
[9] 王捷，李红，穆素红．对影响血液透析患者生存质量心理问题的探讨．透析与人工器官,2001，12(4)：10-11
[10] 刘景芳，陆冬梅．透析病人营养与心理状况分析．社会预防与健康，2000．3(1)：56-57
[11] Ziesat HA .Jr, Logue PE, McCarty SM. Psychological measurement of memory deficits in dialysis patients. Percept Mot Skills 1980, Feb;50(1):311-8
[12] Harum P, Galvez O, Mayol LG, et al. Immediate and delayed memory recall patterns of chronic hemodialysis adult hispanic patients.J Ren Nutr.2003,Apr; 13(2):98-104
[13] 叶任高主编，内科学．北京：人民卫生出版社，2000：569-579
[14] Mendley SR, Zelko FA. Improvement in specific aspects of neurocognitive performance in children after renal transplantation, Kidney Int, 1999, Jul;56(1):318-23. ?
[15] Hulstijn-Dirkmaat GM, Damhuis IH, Jetten ML, Koster AM, Schroder CH.The cognitive development of pre-school children treated for chronic renal failure.Pediatr Nephrol, 1995, Aug;9(4):464-9
[16] France ,Mendes G. The cognitive potentials in kidney failure before and after hemodialysis. Arq. Neuro-Psiquiatr,2000,58(1): 198
[17] MacCracken MA. Anemia management practices in peritoneal dialysis patients. Case study of the anemic patient. Nephrol Nurs J. 2001,Aug;28(4):435-8. Review.
[18] D J Burn, D Bates Neurologe and the kidney. Neurol Neurosurg Psychiatry, 1998,65:810-812
[19] 肖玮，苗丹民，王京生等。内田-克莱佩林测验在民航飞行学员情绪稳定性评价中的应用。中华航空航天医学杂志，
2002，13(3)：148-151．
[20] 谢忠、黄铜等认知行为干预疗法对鼻咽癌放疗病人生存质量的影响 中国临床康复,2001，Russo LS(11)48—49
[21] 周杨，刘传新，马林青．认知行为疗法治疗功能性室性早搏28例．中国行为医学科学，1999．3(8)
[22] 赵鸿韬、龙鲸 认知行为疗法对心脏神经症患者康复治疗的作用中国临床康复2002，2(13)1896—1897
[23] 崔思松，吴正炎等．老年2型糖尿病患者认知功能的研究．老年医学杂志，1992,12(4)210—213
[24] 张银玲．脑认知功能及其哲学思考．医学与哲学,2002,23(3)：16-1844
[25] 史耀芳．语言能力的心理学研究。宁波大学学报(教育科学报)，2000 22，2：25-28
[26] 沈清瑞，叶任高，于血清等。血液净化与移植。北京：人民卫生出版社，1999：69-71
[27] Curtin RB, Klag MJ, Bultman DC, Schatell D. Renal rehabilitation and improved patient outcomes in Texas dialysis facilities. RAm J Kidney Dis. 2002 ,Aug;40(2):331-8
[28] Riley JB Jr, Pristave RJ. Patient's rights in receiving or rejecting dialysis caxe.Nephrol News Issues. 2001 ,Aug; 15(9):49-51
[29] Maier SF, Watkins LR. Immune-to-central nervous system communication and its role in modulating pain and cognition: Implications for cancer and cancer treatment. Brain Behav Immun 2003 Feb;17 Suppl 1:S125-31..
[30] 孟秀枝。49例尿毒症透析前后脑电图分析。河南医药信息，1999，7(6)：11-12
[31] John C.Stivelman. Transplantation Benefits of anaemia treatment on cognitive function. Nephrol Dial Transplant Nephrology Dialysis,2000,15[Suppl3]:29-35
[32] Eschbach, Morehouse RE, Colvin E, Maykut P. Nephrology nurse-patient relationships in the outpatient dialysis setting. Nephrol Nurs J. 2001,Jun;28(3):295-300.
[33] 李家萍。红细胞生成素治疗血液透析贫血患者给药途径的临床研究。护理学杂志，2000，15(3)：137-138
[34] Courts NF .Psychosocial adjustment of patients on home hemodialysis and their dialysis partners. Clin Nurs Res. 2000, May; 9(2):177-90
[35] Curtin RB, Klag MJ, Bultman DC, Schatell D. Renal rehabilitation and improved patient outcomes in Texas dialysis facilities. Am J Kidney Dis. 2002,Aug;40(2):331-8
[36] 王文，王汉民．应对方式和社会支持对行血液透析治疗的终末期肾病患者心理状况的影响．中国临床康复,2002,(6)9：1297-1298
[37] J Ren Nutr. Do we need a nutrition-specific quality of life questionnaire for dialysis patients? 2003, Oct;13(4):295-302., Beale G, Sandroni S, et al. Aluminium intoxication in undialysed adults with chronic renal failure. J Neurol Neurosurg Psychiatry, 1992,55(8):697-700
[38] Ziesat HA Jr, Logue PE, McCarty SM. Psychological measurement of memory deficits in dialysis patients,1980 Feb;50(1):311-8
[39] Psychol Rev. Cytokines for psychologists: implications of bidirectional immune-to-brain communication for understanding behavior, mood,and cognition.Brain Behav Immun. 1998 Jan;105(1):83-107
[40] Moss AH. Recommendations regarding conflict resolution and forgoing dialysis in special patient populations. Nephrol News Issues. 2001 ,Dec; 15 (13): 51-4.
[41] Rau-Foster M.The dialysis facility's rights, responsibilities, and duties when there is conflict with family members. Nephrol News Issues. 2001 ,Apr; 15(5): 12-4.
[42] Prolo P, Chiappelli F, Fiorucci A, Dovio A, Sartori ML, Angeli A. Psychoneuroimmunology: new avenues of research for the twenty-first century. Ann N Y Acad Sci. 2002 Jun;966:400-8. Review
[43] Morehouse RE, Colvin E, Maykut P. Nephrology nurse-patient relationships in the outpatient dialysis setting. Nephrol Nurs J. 2001,Jun;28(3):295-300.
[44] Curtin RB, Mapes DL. Health care management strategies of long-term dialysis survivors. Nephrol Nurs J.2001 Aug; 28(4): 385-92; discussion 393-4.
[45] J Am Geriatr Soc.Cytokines and cognition—the case for a
head-to-toe inflammatory paradigm. Brain Behav Immun.2002, Dec;50(12):2041-56
[46] 沈政．脑认知功能的理论框架与方法学基础[J]．北京大学学报(自然科学版)．1998,34(2-3)：401-408
[47] 魏景汉．关于汉语ERP的研究，汉语的认知研究．济南：山东人民出版社，1997
[48] 寿天德．视觉信息处理的脑机制．上海：科技教育出版社，1997：23-56
[49] PerlmuHer Lc.et al.Am Jmed 1984,77:1043
[50] Mooradian AD.etal,Arch Intern med 1988:148:2369
[51] Eschbach JW, Varma A, Stivelman JC. Is it time for a paradigm shift? Is erythropoietin deficiency still the main cause of renal anaemia? Nephrol Dial Transplant, 2002; 17 Suppl 5:2-7