中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
15期
1710-1714
,共5页
李艳艳%高连波%田沈%周环%王正则
李豔豔%高連波%田瀋%週環%王正則
리염염%고련파%전침%주배%왕정칙
颈动脉狭窄%颈动脉支架%认知障碍
頸動脈狹窄%頸動脈支架%認知障礙
경동맥협착%경동맥지가%인지장애
Carotid stenosis%Carotid artery stenting%Cognition disorders
目的:探讨颈动脉支架植入治疗、药物治疗对不同程度颈动脉狭窄患者认知功能的影响。方法选取2011年12月-2012年12月在中国医科大学附属第四医院神经内科住院治疗的颈动脉狭窄患者51例(病例组)及无颈动脉狭窄患者17例(对照组)。根据单侧颈动脉狭窄率,将病例组患者分为轻度狭窄组(狭窄率为0~50%,20例)、中度狭窄组(狭窄率为51%~70%,15例)、重度狭窄组(狭窄率>70%,16例),其中轻度狭窄组患者接受规范的药物治疗,中度和重度组患者接受支架植入术。采用简易智能精神状态检查量表(MMSE)、顺背测试、连线测试B、韦氏智能量表中的词汇测试及数字符号测试比较患者的认知功能,然后比较轻度狭窄组患者药物治疗前后及中度、重度狭窄组患者支架植入治疗前后认知功能的改变。结果(1)与对照组比较,轻度狭窄组患者的顺背测试、词汇测试、数字符号测试得分降低;中度狭窄组患者的顺背测试、数字符号测试得分降低,连线测试 B 得分升高;重度狭窄组患者的 MMSE、顺背测试、词汇测试、数字符号测试得分降低,连线测试 B 得分升高(P <0.05)。(2)与治疗前比较,轻度狭窄组患者药物治疗3个月、6个月 MMSE、顺背测试、词汇测试、数字符号测试得分升高,连线测试 B 得分降低(P <0.05);中度狭窄组患者支架植入治疗后1个月顺背测试、词汇测试得分升高,连线测试 B 得分降低,而治疗后3个月、6个月患者认知功能的5个指标均改善(P <0.05);重度狭窄组患者支架植入治疗后1个月、3个月、6个月 MMSE、顺背测试得分升高,连线测试 B 得分降低(P <0.05)。结论(1)颈动脉狭窄患者存在认知功能障碍,且颈动脉狭窄程度不同,患者累及的认知功能领域亦不同。(2)早期规范的药物治疗可以改善轻度颈动脉狭窄患者的认知功能;颈内动脉支架植入术可以改善中度、重度颈动脉狭窄患者的认知功能。
目的:探討頸動脈支架植入治療、藥物治療對不同程度頸動脈狹窄患者認知功能的影響。方法選取2011年12月-2012年12月在中國醫科大學附屬第四醫院神經內科住院治療的頸動脈狹窄患者51例(病例組)及無頸動脈狹窄患者17例(對照組)。根據單側頸動脈狹窄率,將病例組患者分為輕度狹窄組(狹窄率為0~50%,20例)、中度狹窄組(狹窄率為51%~70%,15例)、重度狹窄組(狹窄率>70%,16例),其中輕度狹窄組患者接受規範的藥物治療,中度和重度組患者接受支架植入術。採用簡易智能精神狀態檢查量錶(MMSE)、順揹測試、連線測試B、韋氏智能量錶中的詞彙測試及數字符號測試比較患者的認知功能,然後比較輕度狹窄組患者藥物治療前後及中度、重度狹窄組患者支架植入治療前後認知功能的改變。結果(1)與對照組比較,輕度狹窄組患者的順揹測試、詞彙測試、數字符號測試得分降低;中度狹窄組患者的順揹測試、數字符號測試得分降低,連線測試 B 得分升高;重度狹窄組患者的 MMSE、順揹測試、詞彙測試、數字符號測試得分降低,連線測試 B 得分升高(P <0.05)。(2)與治療前比較,輕度狹窄組患者藥物治療3箇月、6箇月 MMSE、順揹測試、詞彙測試、數字符號測試得分升高,連線測試 B 得分降低(P <0.05);中度狹窄組患者支架植入治療後1箇月順揹測試、詞彙測試得分升高,連線測試 B 得分降低,而治療後3箇月、6箇月患者認知功能的5箇指標均改善(P <0.05);重度狹窄組患者支架植入治療後1箇月、3箇月、6箇月 MMSE、順揹測試得分升高,連線測試 B 得分降低(P <0.05)。結論(1)頸動脈狹窄患者存在認知功能障礙,且頸動脈狹窄程度不同,患者纍及的認知功能領域亦不同。(2)早期規範的藥物治療可以改善輕度頸動脈狹窄患者的認知功能;頸內動脈支架植入術可以改善中度、重度頸動脈狹窄患者的認知功能。
목적:탐토경동맥지가식입치료、약물치료대불동정도경동맥협착환자인지공능적영향。방법선취2011년12월-2012년12월재중국의과대학부속제사의원신경내과주원치료적경동맥협착환자51례(병례조)급무경동맥협착환자17례(대조조)。근거단측경동맥협착솔,장병례조환자분위경도협착조(협착솔위0~50%,20례)、중도협착조(협착솔위51%~70%,15례)、중도협착조(협착솔>70%,16례),기중경도협착조환자접수규범적약물치료,중도화중도조환자접수지가식입술。채용간역지능정신상태검사량표(MMSE)、순배측시、련선측시B、위씨지능량표중적사회측시급수자부호측시비교환자적인지공능,연후비교경도협착조환자약물치료전후급중도、중도협착조환자지가식입치료전후인지공능적개변。결과(1)여대조조비교,경도협착조환자적순배측시、사회측시、수자부호측시득분강저;중도협착조환자적순배측시、수자부호측시득분강저,련선측시 B 득분승고;중도협착조환자적 MMSE、순배측시、사회측시、수자부호측시득분강저,련선측시 B 득분승고(P <0.05)。(2)여치료전비교,경도협착조환자약물치료3개월、6개월 MMSE、순배측시、사회측시、수자부호측시득분승고,련선측시 B 득분강저(P <0.05);중도협착조환자지가식입치료후1개월순배측시、사회측시득분승고,련선측시 B 득분강저,이치료후3개월、6개월환자인지공능적5개지표균개선(P <0.05);중도협착조환자지가식입치료후1개월、3개월、6개월 MMSE、순배측시득분승고,련선측시 B 득분강저(P <0.05)。결론(1)경동맥협착환자존재인지공능장애,차경동맥협착정도불동,환자루급적인지공능영역역불동。(2)조기규범적약물치료가이개선경도경동맥협착환자적인지공능;경내동맥지가식입술가이개선중도、중도경동맥협착환자적인지공능。
Objective To explore the influence of carotid stenting and drug therapy on cognitive function in patients with different degrees of carotid stenosis. Methods 51 patients with carotid stenosis(case group)and 17 patients without carotid stenosis(control group)were enrolled in the study when they were admitted to the department of neurology,the Fourth Affiliated Hospital of China Medical University from December 2011 to December 2012. Case group patients were divided into 3 groups ac-cording to rate of unilateral carotid stenosis:mild stenosis group(stenosis rate:0 - 50% ,twenty cases),moderate stenosis group(stenosis rate:51% - 70% ,fifteen cases),severe stenosis group(stenosis rate: > 70% ,sixteen cases). Patients in mild stenosis group received standard medical treatment,moderate and severe stenosis group received carotid stenting. Cognitive function of patients was assessed by Mini - Mental State Examination(MMSE),forward digital span,trail - making B,words test and digital symbol test of Wechsler Adult Intelligence Scale of Chinese Version(WAIS - RC),cognitive function was com-pared among four groups. And cognitive function of mild stenosis group was compared before and after drug therapy,cognitive function of moderate stenosis group and severe stenosis group was compared before and after carotid stenting. Results Compared with control group,patients in mild stenosis group got lower score in forward digital span,words test and digit symbol test;Pa-tients in moderate stenosis group got lower score in forward digital span and digit symbol test,but got higher score in trail - mak-ing B test;Patients in severe stenosis group got lower score in MMSE,forward digital span,words test and digital symbol test, but got higher score in trail - making B test(P < 0. 05). Compared with score before treatment,patients in mild stenosis group got higher score in MMSE,forward digital span,words test and digit symbol test,and got lower score in trail - making B test 3 months and 6 months after drug therapy(P < 0. 05);Patients in moderate stenosis group got higher score in forward digital span, words test,and got lowerscore in trail - making B test 1 month after stenting(P < 0. 05),and 3 months and 6 months after stenting,5 cognitive function indicators improved(P < 0. 05);Patients in severe stenosis group got higher score in MMSE,for-ward digital span,and got lower score in trail - making B test 1 month,3 months,6 months after stenting(P < 0. 05). Con-clusion Patients with carotid stenosis have cognitive dysfunction,the degree of stenosis relate to affected areas of cognitive func-tion. Early standard drug therapy can improve cognitive function of patients with mild carotid stenosis;Internal carotid stenting can improve cognitive function of patients with moderate and severe carotid stenosis.