目的 调查国内养老机构痴呆照护服务现状,为今后国内进一步推进养老机构痴呆照护服务的发展提供可借鉴的依据。方法 2024年1月1日至3月31日以全国养老机构为研究对象, 采取两阶段分层抽样, 随机抽取国内15个省、自治区、直辖市的养老机构, 采用网络问卷调查方法对抽取的养老机构管理人员进行问卷调查。结果 共回收线上调查问卷443份, 经过去重和排除无效问卷, 最终得到的有效问卷为412份, 有效率为93%。调查发现有313家（76%）机构有收住痴呆患者, 养老床位规模为100~299张的养老机构占比最高。小规模的养老机构中,民办民营机构收住痴呆患者的比例高于公建公营机构。有181家机构设置了痴呆照护专区。床位数在300张以上的养老机构中设立痴呆照护专区的比例高于中、小规模的养老机构。结论 本调查较客观地呈现了我国养老机构痴呆照护服务开展的现状, 大规模的养老机构提供痴呆照护服务的能力更高, 设置痴呆照护专区的机构更能满足痴呆患者多层次、多样化的照护需求。目前国内仍存在专业化的痴呆照护服务供给不足、照护人员短缺等现象,  急需国家加强顶层设计,  促进行业健康发展。

       Objective To explore the current situation of cognitive care services in nursing homes in China, and provide reference for further promoting the development of cognitive care services in nursing homes in China．Methods From January 1 to March 31, 2024, a two-stage stratified sampling was carried out to randomly select pension institutions in 15 provinces, autonomous regions and municipalities directly under the central government across the country, and a questionnaire survey was conducted on the nursing homes．Results A total of 443 online questionnaires were recovered in this survey, and 412 valid questionnaires were obtained after eliminating duplicated and invalid questionnaires, with an effective rate of 93%．In this survey, 76% of the institutions admitted the elderly with dementia, and the nursing homes with 100-299 beds accounted for the highest proportion．Among the small-scale nursing homes, the proportion of the elderly with dementia in private institutions is significantly greater than that in public institutions．There were 181 nursing homes with special cognitive care areas．The proportion of cognitive care area in nursing homes with more than 300 beds was significantly greater than that in medium and small scale nursing homes．Conclusions This survey Objectively presents the current situation of the development of cognitive care services in nursing homes in our country．Large-scale nursing homes have a higher capacity to provide cognitive care services．Nursing homes that set up special areas for cognitive care can better meet the multi-level and diversified care needs of the elderly with dementia．At present, there are still insufficient supply of professional cognitive care services and shortage of nursing personnel in China．It is urgent for the country to strengthen top-level design and promote the healthy development of the industry．

目的 观察蒜氨酸对血管性痴呆(VD)脑损伤的作用,并探讨其可能的作用机制。方法 采用随机数字表法将40只大鼠分为假手术组、模型组、蒜氨酸低、中、高剂量组,每组大鼠为8只。模型组和蒜氨酸组采用双侧颈总动脉结扎建立VD大鼠模型。造模7 d后蒜氨酸组分别给予蒜氨酸10、20、30 mg/kg灌胃治疗,假手术组和模型组给予等量生理盐水灌胃治疗,每组均为1次/d,共4周。采用Morris水迷宫实验检测大鼠学习记忆能力,ELISA法检测大鼠海马超氧化物歧化酶(SOD)活性,蛋白免疫印迹法(Western blotting)检测大鼠海马iNOS、IL-1β及TNF-α蛋白的表达。结果 与假手术组相比,模型组大鼠逃避潜伏期延长,找到平台次数减少,SOD活性降低,iNOS、IL-1β及TNF-α蛋白表达量增加,差异均有统计学意义(P＜0.05);与模型组相比,蒜氨酸各剂量组大鼠潜伏期缩短,找到平台次数增多,SOD活性增高,iNOS、IL-1β及TNF-α蛋白表达量减少,差异均有统计学意义(P＜0.05)。结论 蒜氨酸能改善血管性痴呆大鼠的学习记忆能力,其机制可能与其抗氧化应激,抑制相关炎症因子的释放有关。

目的 探讨代谢综合征(metabolic syndrome, MS)(指包括高血压,糖尿病,高脂血症和腹型肥胖的一组综合征)在中国南方老年病人的患病率、及其与心血管事件和痴呆关系。方法 本研究为一个中国南方老年人代谢综合征的横断面研究。我们采集了患者的病史、人口学和生化资料。对比生化资料、心血管事件、痴呆等疾病在MS组和非MS组中的差异,并使用Logistic回归分析来寻找MS的独立影响因子。结果 本研究共纳入206例患者。其中有92(44.66%)例患者符合代谢综合征的诊断标准。女性在MS组中35例(38.04%)明显高于在非MS组中28例(24.56%)。整体年龄(86.74± 6.10),在MS组(86.37±5.74)和非MS组(87.04±6.38)对比中无统计学意义。生化资料对比中,白细胞[(7.46±2.38) vs (6.46±2.35),P=0.003]和血肌酐[94.50(68.50, 129.33) vs 78.00(64.50, 99.75),P=0.004]在MS组中较高。Logistics单因素回归分析及多因素回顾分析提示白细胞、血肌酐和女性为MS的独立风险因子。心肌梗塞(35例,38.04%和心绞痛(28例, 24.56%)在MS组中明显高于非MS组中心肌梗塞(10例,8.77%)和心绞痛(39例,34.21%),两组比较有统计学意义,Logistics回归分析发现MS是心肌梗塞和心绞痛的独立影响因子;但是心衰和中风在两组对比中无统计学差别。痴呆(包括老年性痴呆和血管性痴呆)在MS组中明显低于非MS组:26例(28.26%)vs 50例(43.86%),提示MS可能对痴呆有预防作用。结论 MS在中国南方老年患者中普遍存在,女性、白细胞、血肌酐为MS的独立影响因子;MS是心肌梗塞和心绞痛的独立影响因子;MS中痴呆明显低于非MS组,可能对痴呆有预防保护性作用。

Objective To study the prevalence and correlation between the metabolic syndrome MS (including hypertension, diabetes, hyperlipidemia and obesity) with cardiovascular and dementia in the elderly people of south China. Methods This cross-sectional research studied metabolic syndrome of the elderly in south China. We collected the demographics and chemotic data and compared them in MS and non-MS group. And Logistic regression was used to analyze the independent factor of MS and the relationship between MS and the cardiovascular disease and dementia. Results This study included 206 patients and 92 (44.66%) of them were diagnosed as MS. 35 patients (38.04%) in MS group were female and 28 female cases (24.56%) in non-MS group. The mean age of the sample was (86.74±6.10) and the comparison between the MS group (86.37±5.74) and non-MS group (87.04±6.38) was not significantly different. White blood cell (WBC) (7.46±2.38 vs 6.46±2.35,P=0.003) and serum creatinine (Scr) was significantly [94.50(68.50,129.33) vs 78.00(64.50, 99.75),P=0.004]in MS group versus in non-MS group. Single factor and Multinomial logistic regression found WBC, serum creatinine and female gender were the independent risk factors of MS. Myocardial infarction (35, 38.04%) and angina (28, 24.56%) were significantly higher in MS group than that in non-MS group (10, 8.77%) and (39, 34.21%), respectively, with P<0.05. Logistic regression found MS was an independent risk factor of myocardial infarction and angina but not in heart failure and stroke. Dementia (including Alzheimer disease and vascular dementia) was found lower in MS group (26, 28.26%) than that in non-MS group (50, 43.86%), the difference was significant and this means MS could be protective for dementia. Conclusion MS is prevalent in the elderly of south China. Female gender, WBC and Scr were independent factors of MS; MS was the independent risk factor of myocardial infarction and angina; dementia was significantly lower in MS group, implying MS could be protective to dementia.

       目的   构建痴呆照护人员能力指标体系。方法   通过文献回顾和实况调查初步拟定养老机构痴呆照护人员能力指标体系，采用德尔菲法逐步筛选确定最终所纳入指标。结果   两轮专家函询问卷回收率均为100%，专家权威系数第一轮为0.93、第二轮为0.92，专家协调度好。最终形成包括初级照护人员一级指标8项，二级指标21项；中级照护人员一级指标12项，二级指标46项；高级照护人员一级指标13项，二级指标56项的痴呆照护人员能力指标体系。结论   本研究构建的痴呆照护人员能力指标体系具有较好的科学性、可靠性、实用性和指导性，为痴呆照护人员能力培训及技能考核提供依据。

       Objective  To construct the system of indicators of capability for dementia caregivers．Methods  Through literature review and survey，the system of indicators of capability of dementia caregivers in nursing homes was initially formulated，and the Delphi method was used to gradually screen and determine the final included indicators．Results  The recovery rate of the two rounds of expert letter inquiries was 100%．The expert authority coefficient was 0.93 in the first round and 0.92 in the second round．The coordination of experts was good．The final indicators of capability system for dementia caregivers included 8 first-level indicators and 21 second-level indicators for primary caregivers，12 first-level indicators and 46 second-level indicators for secondary caregivers，and 13 first-level indicators and 56 second-level indicators for senior caregivers．Conclusions  The indicators of capability system for dementia caregivers constructed in this study has good scientificity，reliability，practicality and guidance，which provides a basis for the ability training and skill assessment of dementia caregivers．