立体定向双侧伏隔核射频毁损对阿片类药物成瘾者认知功能的影响  

Evaluation of cognitive functions in opiate addicts of ablating the nucleus accumbens via stereotactic surgery

作　　者：李立宏[1] 何飞[1] 常崇旺[1] 王学廉[1] 耿宁[1] 赵巍[1] 高国栋[1] 

机构地区：[1]第四军医大学唐都医院神经外科,全军功能神经外科研究所,西安710038

出　　处：《立体定向和功能性神经外科杂志》2009年第1期21-24,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探讨实施立体定向双侧伏隔核射频毁损术后不同阶段阿片类药物成瘾者认知功能变化,主要包括智力及记忆力功能变化。方法采用韦克斯勒成人智力量表(wechsler adult intelligence scale,WAIS-RS)、临床记忆量表(clinical memory scale,CMS)和唐都医院神经外科自编随访问卷,对30例阿片类药物成瘾者术前与术后不同时间段进行测评。结果韦氏量表测评结果表明,术后90天言语智商(VIQ)、操作智商(PIQ)、总智商(IQ)无显著性差异(P>0.05);但数字广度分测验和数字符号分测验较术前明显下降(P<0.05);临床记忆量表测评结果表明,指向记忆、联系学习、图像自由回忆手术前后存在明显差异(P<0.05),记忆商数术后较术前明显下降(P<0.05);在6个月和12个月的随访问卷调查结果表明智力功能无明显变化,记忆力情况随躯体康复及回归社会后心理变化程度逐步好转,通过特殊的记忆力训练可有所提高。结论毁损伏隔核内特定亚区对药物成瘾者智力总体状况无显著影响;仅对短时记忆、注意力有一定近期影响,但长期随访无明显影响;提示伏隔核内可能存在与短时记忆、注意力相关的亚区或通路。Objective This study explored the cognitive functions of opiate addicts who have been ablated preferred target zones within the nucleus accumbens （NAC） via stereotactic surgery for alleviating opiate psychological dependence. Methods Thirty opiate addicts were assessed by standardized Wechsler Adult Intelligence Scale--Revised Chinese （WAIS--RC） and Clinical Memory Scale of Chinese （CMS） both before and approximately 3 months after the stereotactic surgery. The evaluation of cognitive domains included intelligence and memory. Results Compared with preoperation, there was no statistically significant difference in full--scale intelligence quotient （IQ） postoperatively, but a statistical significant decline （P〈0.05） was observed in Digit symbol--substitution subtest and Digit span subtest of WAIS--RC. The memory quotient （MQ） of CMS demonstrated statistical significant decline （P〈0. 05） postoperatively. Although the patients＇ intellectual function has not changed significantly, their short--term memory and attention declined significantly after postoperation. Conclusion It might be speculated that the therapy of ablating NAC via stereotactic surgery in opiate addicts can be associated with short--term negative cognitive functions. Advisement regarding the safety of the new surgical modality and recommendations for future long--term clinical investigation are necessary.

关 键 词：立体定向 伏隔核 药物成瘾 认知功能 心理依赖 

分 类 号：R996[医药卫生—毒理学]