摘要
目的:探讨重度主动脉瓣疾病患者行经导管主动脉瓣置换术(TAVR)后1年内认知功能的改变。方法:收集2019年10月至2020年9月期间于我院成功行TAVR治疗并完成1年随访的87例重度主动脉瓣疾病患者的临床及随访资料。所有患者在TAVR术前与术后常规接受头颅MRI检查;并于TAVR术前、术后30 d及1年时常规接受简易精神状态量表(MMSE)评估认知功能。根据术前MMSE得分情况将患者分为认知功能正常组(>24分,n=48)和认知功能受损组(≤24分,n=39),分析和对比两组患者术后认知功能变化趋势。结果:39例(44.8%)患者术前存在认知功能受损。认知功能正常组与认知功能受损组术后脑梗死灶发生率、数目、总体积及平均体积差异均无统计学意义(P均>0.05)。认知功能正常组患者TAVR术前、术后30 d及1年认知功能的差异无统计学意义[(27.13±1.61)分vs(.26.65±2.32)分vs.(26.46±2.21)分,P>0.05]。认知功能受损组术后30 d认知功能较术前明显改善[(21.69±3.68)分vs(.20.26±3.23)分,P=0.008],该改善效果可维持至术后1年[(21.00±3.74)分vs.(21.69±3.68)分,P=0.607]。此外,头颅MRI弥散加权成像发现,有63例(72.4%)患者出现术后新发梗死灶,未见新发脑梗死灶患者术后30 d认知功能较术前明显改善[(25.04±3.74)分vs.(23.38±4.72)分,P<0.001]。结论:成功接受TAVR治疗的重度主动脉瓣疾病患者中,术前认知功能正常的患者术后认知功能未见受损,术前认知功能受损的患者术后出现一定程度的改善。两组间术后新发脑梗死灶未见明显差异。
Objectives:To investigate the change trend of cognitive function status of patients with severe aortic valve disease within 1 year after transcatheter aortic valve replacement(TAVR).Methods:From October 2019 to September 2020,the baseline and follow-up clinical data of 87 patients with severe aortic valve disease who were successfully treated with TAVR in our hospital and completed 1-year follow-up were collected.Before and after TAVR treatment,all patients underwent routine brain magnetic resonance imaging.All patients were routinely assessed based on the Mini-Mental State Examination(MMSE)at baseline,30 days and 1 year after TAVR.According to the baseline MMSE score,the patients were divided into the normal(>24 points,n=48)and impaired(≤24 points,n=39)cognitive function groups.The change trends of cognitive function between these two groups were analyzed and compared.Results:Thirty-nine patients(44.8%)had impaired cognitive function at baseline.There were no significant differences in the incidence,number,total volume and volume per lesion of new cerebral lesions between the normal and impaired cognitive function groups(all P>0.05).The cognitive function status of the normal group at baseline,30 days and 1 year after procedure showed no significant change([27.13±1.61]vs.[26.65±2.32]vs.[26.46±2.21],P>0.05).In the impaired cognitive function group,the cognitive function status was significantly improved at 30 days after procedure([21.69±3.68]vs.[20.26±3.23],P=0.008),and the improvement could be maintained to 1 year after TAVR([21.00±3.74]vs.[21.69±3.68],P=0.607).In addition,new cerebral lesions were found in 63 patients(72.4%)after TAVR in DW-MRI.And the cognitive function status of patients without new cerebral lesions was significantly improved at 30 days post-procedural compared to the baseline([25.04±3.74]vs.[23.38±4.72],P<0.001).Conclusions:Among the patients with severe aortic valve disease who successfully undergoing TAVR,the patients with normal preoperative cognitive function showed no postope
作者
陈俊
朱齐丰
戴晗怡
周道
刘琼
胡王兴
许烨铭
阿不都吾甫尔·依迪力斯
陈毓文
任凯达
范嘉祺
郭宇超
何宇欣
刘先宝
王建安
CHEN Jun;ZHU Qifeng;DAI Hanyi;ZHOU Dao;LIU Qiong;HU Wangxnig;XU Yeming;Abuduwufuer Yidilisi;CHEN Yuwen;REN Kaida;FAN Jiaqi;GUO Yuchao;HE Yuxin;LIU Xianbao;WANG Jian’an(Department of Cardiology,The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou(310000),Zhejiang,China)
出处
《中国循环杂志》
CSCD
北大核心
2022年第4期393-398,共6页
Chinese Circulation Journal
基金
浙江省教育厅一般科研项目(Y201941251)
浙江省医药卫生科技项目(2020KY569)。
关键词
经导管主动脉瓣置换术
认知功能
简易精神状态量表
脑损伤
transcatheter aortic valve replacement
cognitive function
mini-mental state examination
brain injury
