CAJ | 학술논문

目的：探究颈动脉狭窄(CAS)合并认知功能障碍(CI)患者支架植入后脑血流动力学(CHD)变化，以及CHD改善与CI的关系。方法选择江门市中心医院神经内科一区2012年1月至2013年6月入院的CAS合并CI患者26例，所有患者均行颈动脉支架植入术，分别在术前和术后采用蒙特利尔认知估量表(Montreal cognitive assessment，MoCA)、简易精神评估量表(MMSE)评价患者的认知功能，同时以64排螺旋CT进行灌注成像显影(CTP)，统计患者狭窄血管供血区和非供血区(大脑后动脉供血区，一般选取狭窄血管同侧的枕叶)的相对脑血流量(rCBF)、相对脑血容量(rCBV)和相对达峰时间(rTTP)等CHD指标。结果患者MoCA、MMSE得分术前分别为(15.3±3.9)分、(21.0±3.4)分，术后3个月分别为(20.6±3.4)分、(25.2±3.0)分，术前术后MoCA、MMSE得分比较差异具有统计学意义(P<0.05)；狭窄血管供血区术前rCBF、rCBV和rTTP得分分别为(0.98±0.15)分、(0.97±0.12)分和(1.05±0.11)分，而术后分别为(0.96±0.11)分、(0.97±0.14)分和(1.00±0.06)分，rCBF和rTTP术前术后差异具有统计学意义(P<0.05)。结论支架植入手术能显著改善CAS合并CI患者的CHD，同时也能改善患者的认知功能。
목적：탐구경동맥협착(CAS)합병인지공능장애(CI)환자지가식입후뇌혈류동역학(CHD)변화，이급CHD개선여CI적관계。방법선택강문시중심의원신경내과일구2012년1월지2013년6월입원적CAS합병CI환자26례，소유환자균행경동맥지가식입술，분별재술전화술후채용몽특리이인지고량표(Montreal cognitive assessment，MoCA)、간역정신평고량표(MMSE)평개환자적인지공능，동시이64배라선CT진행관주성상현영(CTP)，통계환자협착혈관공혈구화비공혈구(대뇌후동맥공혈구，일반선취협착혈관동측적침협)적상대뇌혈류량(rCBF)、상대뇌혈용량(rCBV)화상대체봉시간(rTTP)등CHD지표。결과환자MoCA、MMSE득분술전분별위(15.3±3.9)분、(21.0±3.4)분，술후3개월분별위(20.6±3.4)분、(25.2±3.0)분，술전술후MoCA、MMSE득분비교차이구유통계학의의(P<0.05)；협착혈관공혈구술전rCBF、rCBV화rTTP득분분별위(0.98±0.15)분、(0.97±0.12)분화(1.05±0.11)분，이술후분별위(0.96±0.11)분、(0.97±0.14)분화(1.00±0.06)분，rCBF화rTTP술전술후차이구유통계학의의(P<0.05)。결론지가식입수술능현저개선CAS합병CI환자적CHD，동시야능개선환자적인지공능。
Objective To explore the changes of cerebral hemodynamic in patients with carotid artery steno-sis (CAS) combined cognitive impairment (CI) after stent implantation, and the relationship between CI improvement and cognitive function improvement. Methods Twenty-six patients with CAS combined CI in the first District of De-partment of Neurology in Central Hospital of Jiangmen from January 2012 to June 2013 were selected, all of which underwent carotid stent implantation. Montreal Cognitive Assessment (MoCA) and mini-mental state examination (MMSE) were used to evaluate patients’cognitive function at preoperative and postoperative, respectively, while 64-slice spiral CT was used to do Computed Tomography Perfusion (CTP). CHD indicators, such as relative cerebral blood vessels flow (rCBF), relative cerebral blood volume (rCBV) and relative time to peak (rTTP) at supply and non-supply area in narrow vessels, were recorded. Results MoCA and MMSE score were (15.3±3.9) and (21.0±3.4), respectively, before the operation, which were (20.6±3.4) and (25.2±3.0), respectively, 3 months after operation. In pa-tients, there were statistically significant differences in MoCA and MMSE score before and after surgery (P<0.05). The rCBF, rCBV and rTTP at narrow vessels area were (0.98 ± 0.15), (0.98 ± 0.15) and (1.05 ± 0.11), respectively, be-fore the operation, while which were (0.96 ± 0.11), (0.97 ± 0.14) and (1.00 ± 0.06), respectively, 3 months after opera-tion. There were statistically significant differences in rCBF and rTTP between before and after surgery (P<0.05). Conclusion Stent implantation surgery could significantly improve CHD in patients with CAS combined CI, which could also improve cognitive function in patient.