中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2014年
8期
602-607
,共6页
王旗%张明%黄佃%周瑜%乔彤
王旂%張明%黃佃%週瑜%喬彤
왕기%장명%황전%주유%교동
颈动脉疾病%动脉粥样硬化%颈动脉内膜切除术%认知功能障碍%磁共振成像,弥散
頸動脈疾病%動脈粥樣硬化%頸動脈內膜切除術%認知功能障礙%磁共振成像,瀰散
경동맥질병%동맥죽양경화%경동맥내막절제술%인지공능장애%자공진성상,미산
Carotid artery disease%Atherosclerosis%Endarterectomy,carotid%Cognition disorders%Diffusion magnetic resonance imaging
目的 探讨颈动脉内膜剥脱术(CEA)对颈动脉粥样硬化狭窄(CAS)患者认知功能的治疗改善作用.方法 对2011年12月至2013年7月入院并符合纳入标准的38例CAS患者行CEA术,其中男性26例,女性12例,平均年龄(70±7)岁.左侧颈动脉严重狭窄21例,右侧颈动脉严重狭窄17例.术前1周行头颅磁共振灌注加权成像(PWI)及磁共振弥散加权成像(DWI)检查,并利用简易精神状态量表(MMSE)及蒙特利尔认知量表(MoCA)评估患者认知、情感情况.术后4周复查MRI,术后6周复查MMSE及MoCA,评价CEA对患者脑灌注及认知功能的改善效果.结果 PWI结果显示,术后病变侧灌注情况较术前明显改善,血流达峰时间(29 ±9比23 ±4)、相对平均通过时间(22 ±8比14 ±6)、血流到达时间(21 ±8比15 ±4)明显缩短,相对脑血容量(11.6±3.5比7.5±3.2)明显下降(t=1.31 ～5.24,均P＜0.05).术前MMSE及MoCA评估发现35例CAS患者存在不同程度的认知功能障碍;术后患者MMSE评分较术前无明显变化,而术后MoCA评分较术前有显著提高(20.4±1.5比22.0±1.6,t=-4.25,P=0.000);MoCA单项评分中,视空间执行能力(2.4±0.9比2.8±0.7)、命名(2.0±0.7比2.3±0.6)、注意力(2.3±0.6比2.6±0.5)及抽象概括能力(1.2±0.7比1.6±0.6)与术前相比差异有统计学意义(t=0.015 ～0.029,均P＜0.05).结论 CEA在有效增加CAS患者大脑灌注的同时可以不同程度地改善CAS患者的认知功能障碍,对由颈动脉狭窄引起的轻度血管性认知功能障碍有一定的治疗作用.
目的 探討頸動脈內膜剝脫術(CEA)對頸動脈粥樣硬化狹窄(CAS)患者認知功能的治療改善作用.方法 對2011年12月至2013年7月入院併符閤納入標準的38例CAS患者行CEA術,其中男性26例,女性12例,平均年齡(70±7)歲.左側頸動脈嚴重狹窄21例,右側頸動脈嚴重狹窄17例.術前1週行頭顱磁共振灌註加權成像(PWI)及磁共振瀰散加權成像(DWI)檢查,併利用簡易精神狀態量錶(MMSE)及矇特利爾認知量錶(MoCA)評估患者認知、情感情況.術後4週複查MRI,術後6週複查MMSE及MoCA,評價CEA對患者腦灌註及認知功能的改善效果.結果 PWI結果顯示,術後病變側灌註情況較術前明顯改善,血流達峰時間(29 ±9比23 ±4)、相對平均通過時間(22 ±8比14 ±6)、血流到達時間(21 ±8比15 ±4)明顯縮短,相對腦血容量(11.6±3.5比7.5±3.2)明顯下降(t=1.31 ～5.24,均P＜0.05).術前MMSE及MoCA評估髮現35例CAS患者存在不同程度的認知功能障礙;術後患者MMSE評分較術前無明顯變化,而術後MoCA評分較術前有顯著提高(20.4±1.5比22.0±1.6,t=-4.25,P=0.000);MoCA單項評分中,視空間執行能力(2.4±0.9比2.8±0.7)、命名(2.0±0.7比2.3±0.6)、註意力(2.3±0.6比2.6±0.5)及抽象概括能力(1.2±0.7比1.6±0.6)與術前相比差異有統計學意義(t=0.015 ～0.029,均P＜0.05).結論 CEA在有效增加CAS患者大腦灌註的同時可以不同程度地改善CAS患者的認知功能障礙,對由頸動脈狹窄引起的輕度血管性認知功能障礙有一定的治療作用.
목적 탐토경동맥내막박탈술(CEA)대경동맥죽양경화협착(CAS)환자인지공능적치료개선작용.방법 대2011년12월지2013년7월입원병부합납입표준적38례CAS환자행CEA술,기중남성26례,녀성12례,평균년령(70±7)세.좌측경동맥엄중협착21례,우측경동맥엄중협착17례.술전1주행두로자공진관주가권성상(PWI)급자공진미산가권성상(DWI)검사,병이용간역정신상태량표(MMSE)급몽특리이인지량표(MoCA)평고환자인지、정감정황.술후4주복사MRI,술후6주복사MMSE급MoCA,평개CEA대환자뇌관주급인지공능적개선효과.결과 PWI결과현시,술후병변측관주정황교술전명현개선,혈류체봉시간(29 ±9비23 ±4)、상대평균통과시간(22 ±8비14 ±6)、혈류도체시간(21 ±8비15 ±4)명현축단,상대뇌혈용량(11.6±3.5비7.5±3.2)명현하강(t=1.31 ～5.24,균P＜0.05).술전MMSE급MoCA평고발현35례CAS환자존재불동정도적인지공능장애;술후환자MMSE평분교술전무명현변화,이술후MoCA평분교술전유현저제고(20.4±1.5비22.0±1.6,t=-4.25,P=0.000);MoCA단항평분중,시공간집행능력(2.4±0.9비2.8±0.7)、명명(2.0±0.7비2.3±0.6)、주의력(2.3±0.6비2.6±0.5)급추상개괄능력(1.2±0.7비1.6±0.6)여술전상비차이유통계학의의(t=0.015 ～0.029,균P＜0.05).결론 CEA재유효증가CAS환자대뇌관주적동시가이불동정도지개선CAS환자적인지공능장애,대유경동맥협착인기적경도혈관성인지공능장애유일정적치료작용.
Objective To investigate the theraputic effects of carotid endarterectomy (CEA) on cognitive function in patients with carotid stenosis (CAS) and congnitive impairment.Methods CEA was performed on 38 patients with CAS from December 2011 to July 2013.There were 26 male and 12 female patients,with an average age of (70 ± 7) years.Patients was underwent neuropsychological examinations (NPEs) including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at 1 week before and 6 weeks after treatment.Cerebral perfusion was assessed with MR perfusion-weighted imaging and diffusion-weighted inmaging at 1 week before and 6 weeks after treatment.Results All of the 38 patients completed NPEs and MRI at baseline and 6 weeks after CEA.After therapy,the parameters and the extents of abnormal perfusion was improved,including the decrease of time to peak (29 ± 9 vs.23 ± 4),relative mean transit time (22 ±8 vs.14 ±6),arrive time (21 ±8 vs.15 ±4) and relative cerebral blood volume (11.6 ± 3.5 vs.7.5 ± 3.2) (t =1.31 to 5.24,all P ＜ 0.05).Significant improvement in MoCA (20.4±1.5 vs.22.0±1.6,t=-4.25,P=0.000) but MMSE (26.16 ±1.35 vs.26.47 ±1.52,t=-0.96,P =0.341) was observed.CEA significantly improved the assessment of visuospacial/constructive abilities (2.4 ± 0.9 vs.2.8 ± 0.7),naming (2.0 ± 0.7 vs.2.3 ± 0.6),abstraction (1.2 ± 0.7 vs.1.6 ± 0.6) and attention (2.3 ± 0.6 vs.2.6±0.5) (t=0.015to0.029,P=0.015).Conclusion CEAcan improve the cognitive function of patients with carotid stenosis as well as the cerebral perfusion of patients and has therapeutic effects on vascular mild cognitive impairment.
