摘要
目的探讨颈动脉狭窄患者行颈动脉内膜切除术(CEA)后认知功能的变化情况。方法回顾性分析我院神经外科自2016年9月至2018年5月收治41例行CEA手术治疗的颈动脉狭窄患者的临床资料。分别于术前1周和术后3个月行CT脑灌注检查评估脑血流动力学情况,并使用简易精神状态量表(MMSE)及蒙特利尔认知量表(MoCA)分别对患者手术前后的认知功能进行评分,最后分别比较患者手术前后脑灌注及认知功能的情况。结果 CT脑灌注显示术前病变侧脑灌注情况明显差于对侧,各项脑灌注参数(CBF、CBV、MTT、TTP)差异均具有统计学意义(P <0. 05);术后病变侧脑灌注情况较术前改善,其中脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)差异具有统计学意义(P <0. 05)。术后两侧脑灌注参数比较,仅脑血容量(CBV)差异具有统计学意义(P <0. 05)。对比手术前后MMSE总分差异虽无统计学意义,但单项中延迟回忆评分差异具有统计学意义(P=0. 031)。术后MoCA总分及其单项中视空间/执行能力、抽象能力及延迟回忆评分均显著高于术前,差异具有统计学意义(P <0. 05)。结论颈动脉内膜切除术可以提高颈动脉狭窄患者的脑灌注情况,同时患者的认知功能也出现不同程度的改善。
Objective To investigate the changes of cognitive function in patients with carotid stenosis after carotid endarterectomy(CEA).Methods The clinical data of 41 patients with carotid artery stenosis who treated with CEA in neurosurgery department of the affiliated hospital of Xuzhou medical university from September 2016 to May 2018 were retrospectively analyzed.Cerebral hemodynamics was assessed by CT perfusion at 1 week before and 3 months after surgery.The cognitive function of the patients before and after surgery were evaluated by mini-mental state examination(MMSE)and montreal cognitive assessment(MoCA).Finally,the preoperative and postoperative cerebral perfusion and cognitive function of patients were compared respectively.Results CT cerebral perfusion showed that the preoperative cerebral perfusion of the lesion side was significantly worse than that of the contralateral side,and the differences of various perfusion parameters(CBF,CBV,MTT,TTP)were statistically significant(P<0.05);the postoperative cerebral perfusion of the lesion side was improved compared with that before sugery,and there were significant differences in cerebral blood flow(CBF),mean transit time(MTT)and time to peak(TTP)(P<0.05).Postoperative cerebral perfusion parameters of both sides were compared,only cerebral blood volume(CBV)was significantly different(P<0.05).Although there was no significant difference in the total score of MMSE before and after the operation,the delayed memory score of each item was significant difference(P=0.031).The total score of MoCA after operation and the scores of visuospacial/executive abilities,abstraction and delayed memory in each item were significantly higher than those before operation(P<0.05).Conclusion CEA can improve the cognitive function of patients with carotid stenosis as well as the cerebral perfusion of patients.
作者
王宇生
邱大志
阴鲁鑫
谢满意
王强
李中林
WANG Yu-sheng;QIU Da-zhi;YIN Lu-xin;XIE Man-yi;WANG Qiang;LI Zhong-lin(Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical University,Xuzhou Jiangsu 221000,China)
出处
《局解手术学杂志》
2019年第2期112-117,共6页
Journal of Regional Anatomy and Operative Surgery
基金
国家自然科学基金(81772665)
关键词
颈动脉狭窄
内膜切除术
CT
脑灌注
认知功能障碍
carotid artery stenosis
endarterectomy
CT
cerebral perfusion
cognition disorders
