摘要
目的观察颈动脉支架植入术(Carotid artery stenting,CAS)与单纯药物治疗对出现腔隙性脑梗死的轻度血管性认知障碍患者认知功能影响。方法选取2019年1月~2020年10月于河北医科大学第一医院治疗的腔隙性脑梗死颈动脉狭窄程度>50%的85例患者分为两组,CAS组43例,药物组42例。采集两组患者年龄、文化程度、糖尿病史、高血压史、吸烟史、饮酒史、术前血糖血脂等临床资料,并采用门诊复诊方式随访。于入组时、治疗后1、6和12个月使用中文版蒙特利尔认知评估量表(MoCA)进行认知功能评估。于入组时、治疗后12个月行脑CT灌注检查。动脉闭塞同侧大脑半球的相对脑血容量(relative cerebral blood volume,r CBV),相对平均通过时间(relative mean transit time,r MTT)和相对达峰时间(relative time to peak,r TTP)。结果CAS组的MoCA视空间与执行功能评分在治疗后1、6、12个月时均高于治疗前,注意和延迟回忆评分在治疗后6、12个月时均高于治疗前,差异均有统计学意义(P<0.05)。治疗6、12个月时CAS组的视空间与执行功能、注意、延迟回忆评分高于同时点的药物组评分,组间差异有统计学意义(P<0.05)。命名、语言、抽象、定向评分治疗前后及组间差异均无统计学意义(P>0.05)。治疗前,两组的r CBV、r MTT、r TTP比较,差异无统计学意义(P>0.05)。CAS组术后12个月r MTT和r TTP均明显降低,与术前比较差异均有统计学意义(P<0.05)。药物组各灌注指标无改善,两组治疗12个月后r MTT、r TTP组间差异有统计学意义(P<0.05)。多元logistic回归分析结果显示,年龄、高血压、支架植入与MoCA评分有相关性,年龄和高血压是影响患者认知功能的危险因素,支架植入是保护因素。结论对于合并腔隙性脑梗死,颈动脉狭窄程度>50%的血管性认知功能障碍患者,颈动脉支架置入术较单纯药物治疗更能改善大脑血流灌注,改善认知功能障碍中的视�
Objective To observe the effect of carotid artery stenting(CAS)and simple drug treatment on cognitive function in patients with mild vascular cognitive impairment with lacunar cerebral infarction.Methods 85 patients with lacunar cerebral infarction with carotid stenosis>50%were divided into two groups,43 cases in CAS group and 42 cases in drug group.Age,education level,history of diabetes,history of hypertension,smoking history,drinking history,preoperative blood glucose and blood lipids were collected from two groups.All patients were followed up by outpatient follow-up.The Chinese version of Montreal Cognitive Assessment(MoCA)was used to evaluate the cognitive function at the time of enrollment,1 month,6 months and 12 months after treatment.CT perfusion examination was performed at the time of admission and 12 months after treatment.Relative cerebral blood volume(r CBV),relative mean transit time(r MTT)and relative time to peak(r TTP)in the ipsilateral cerebral hemisphere after arterial occlusion.Results The scores of MoCA visual space and executive function in CAS group were higher than those before treatment at 1,6 and 12 months after treatment,and the scores of attention and delayed recall were higher than those before treatment at 6 and 12 months after treatment(P<0.05)).At 6 and 12 months of treatment,the scores of visual space,executive function,attention and delayed recall in CAS group were higher than those in drug group at the same time point.The difference between the groups was statistically significant(P<0.05)).There was no significant difference in naming,language,abstract and orientation scores before and after treatment and between groups(P>0.05)).Before treatment,there was no significant difference in r CBV,r MTT and r TTP between the two groups(P>0.05)).The r MTT and r TTP in CAS group decreased significantly 12 months after operation,and the difference was statistically significant compared with that before operation,P<0.05).There was no improvement in perfusion indexes in the drug group.After
作者
赵剑
左姗姗
张亚辉
王赞
Zhao Jian;Zuo Shanshan;Zhang Yahui(Intensive Care Unit,the First Hospital of Hebei Medical University,Shijiazhuang 050000,China)
出处
《中华保健医学杂志》
2022年第3期204-207,共4页
Chinese Journal of Health Care and Medicine
基金
河北省卫健委科研课题(20201191)。
关键词
颈动脉狭窄
颈动脉支架植入术
腔隙性脑梗死
血管性认知障碍
Carotid stenosis
Carotid artery stenting
Lacunar cerebral infarction
Vascular cognitive impairment
