颈动脉狭窄合并认知功能障碍患者支架植入后脑血流动力学变化的初步研究  

A preliminary study on the changes of cerebral hemodynamic in patients with carotid artery stenosis combined cognitive impairment after stent implantation

作　　者：陈克强[1] 刁士元[1] 左克扬[2] 孙巧松[1] 

机构地区：[1]江门市中心医院神经内科,广东江门529030 [2]江门市中心医院放射科,广东江门529030

出　　处：《海南医学》2014年第15期2196-2198,共3页Hainan Medical Journal

摘　　要：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。Objective To explore the changes of cerebral hemodynamic in patients with carotid artery stenosis （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 Department 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 patients, 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, before the operation, while which were （0.96 ± 0.11）, （0.97 ± 0.14） and （1.00 ± 0.06）, respectively, 3 months after operation. 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.

关 键 词：颈动脉狭窄 认知功能障碍 支架植入术 蒙特利尔认知估量表 CT灌注成像显影 

分 类 号：R543.4[医药卫生—心血管疾病]