颈动脉内膜斑块切除术改善血管性认知障碍的影响因素研究  

Influence factors of carotid endarterectomy improving vascular cognitive impairment

作　　者：张红刚 张雯[2] 周楚[2] 乔彤[2] Zhang Honggang;Zhang Wen;Zhou Chu;Qiao Tong(Department of Vascular Surgery,Lianyungang Clinical College of Nanjing Medical University,Lianyungang 222000,China;Department of Vascular Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210000,China)

机构地区：[1]南京医科大学连云港临床医学院血管外科,连云港222000 [2]南京大学医学院附属鼓楼医院血管外科,南京210000

出　　处：《中华医学杂志》2019年第4期260-265,共6页National Medical Journal of China

基　　金：江苏省“六大人才高峰”项目(WSN-134).

摘　　要：目的探讨颈动脉内膜斑块切除术(CEA)改善颈动脉狭窄患者认知功能的影响因素。方法回顾性分析2011年12月至2017年7月在南京鼓楼医院及连云港市第一人民医院行CEA的有认知功能障碍的颈动脉狭窄患者临床资料,术前1周行颈动脉CT血管造影检查及头颅磁共振检查,并利用蒙特利尔认知量表(MoCA)评估患者认知功能,术后4周复查磁共振及MoCA。将患者按照术后认知功能评分有无改善分为有改善组(COI+)和无改善组(COI-),比较两组患者的一般资料、颈动脉阻断时间、手术部位、术前颈动脉钙化积分(CS)及Fazekas评分,术前术后脑灌注参数--平均通过时间(MTT)、血流达峰时间(TTP)及血流到达时间(T0)、术后有无新发梗死灶。结果共纳入70例患者,其中COI+组50例,COI-组20例。两组患者的年龄、性别,是否存在高血压、糖尿病、吸烟史、饮酒史,以及颈动脉阻断时间、术前Fazekas评分差异均无统计学意义(均P>0.05)。两组患者术前颈动脉钙化积分分别为469.75±50.86、393.51±77.41,手术前后灌注参数变化ΔMTT分别为7.79±9.51、3.03±6.40,ΔTTP分别为5.83±8.98、1.17±4.77,ΔT0分别为5.89±8.08、3.05±5.95,两组间差异均有统计学意义(t=4.844、2.053、2.192、1.423,均P<0.05)。两组患者术后新发梗死灶比例分别为38%、65%,接受左侧CEA的比例分别为66%、40%,差异均有统计学意义(χ^2=4.197、9.677,均P<0.05)。结论术前颈动脉钙化积分较高、行左侧CEA、术后脑灌注改善明显、术后无新发梗死灶是通过CEA手术改善认知功能的独立影响因素。Objective To investigate the influence factors of carotid endarterectomy(CEA) improving cognitive function in patients with carotid stenosis.MethodsThe clinical data of carotid stenosis patients with cognitive impairment who underwent CEA in Nanjing Drum Tower Hospital and the First People′s Hospital of Lianyungang from December 2011 to July 2017 were retrospectively analyzed. One week before operation, carotid CT angiography and cranial magnetic resonance imaging were performed, and the cognitive function of patients was evaluated with Montreal Cognitive Scale (MoCA). The magnetic resonance imaging and MoCA were reexamined 4 weeks after the procedure. The patients were divided into improved group (COI+) and un-improved group (COI-) according to whether the cognitive function score was improved or not after operation. The general data, carotid artery occlusiontime, surgical site, preoperative carotid calcification score (CS) and the Fazekas score, pre-operative and post-operative cerebral perfusion parameters, like mean transit time(MTT), time to peak(TTP) and arrivetime (T0), and any new infarcts after operation between the two groups were compared.ResultsA total of 70 patients were selected, including 50 patients in group COI+ and 20 patients in group COI-. There were no significant differences in age, gender, hypertension, diabetes mellitus, smoking and drinking habits, as well as in carotid artery occlusiontime and preoperative Fazekas score between the two groups (all P>0.05). The preoperative carotid artery calcification scores of the two groups were 469.75±50.86 and 393.51±77.41, respectively. The changes of pre-and post-operation perfusion parameters between the two groups were statistically significant, with ΔMTT were 7.79±9.51 and 3.03±6.40, ΔTTP were 5.83±8.98 and 1.17±4.77, T0 were 5.89±8.08 and 3.05±5.95, respectively(t=4.844, 2.053, 2.192 and 1.423, respectively, all P<0.05). Proportion of cases with new infarcts after operation(0.38 vs 0.65) or undergoing left CEA (0.66 vs 0.40)between

关 键 词：动脉粥样硬化 认知障碍 颈动脉内膜切除术 

分 类 号：R654.4[医药卫生—外科学]