颈动脉内膜剥脱术对认知功能的影响  

Influence of carotid endarterectomy in cognitive functions

作　　者：何子骏[1] 梁春阳[1] 罗永春[1] 张振海[1] 张强[1] 徐如祥[1] 沈春森[1] 

机构地区：[1]北京军区总医院附属八一脑科医院,北京100700

出　　处：《中华神经医学杂志》2015年第10期1038-1041,共4页Chinese Journal of Neuromedicine

摘　　要：目的观察颈动脉内膜剥脱术对症状性颈动脉狭窄患者认知功能的影响。方法选择自2013年2月至2014年8月在北京军区总医院附属八一脑科医院行颈动脉内膜剥脱术患者43例，分别于术前3d内和术后3个月采用蒙特利尔认知功能量表（MoCA）评价认知功能，CT脑灌注扫描评价脑血流情况，并将术前术后情况进行比较。同时根据术后MoCA评分改善情况，将患者分为明显改善组和无显著改善组，比较2组患者脑血流动力学指标手术前后变化情况。结果（1）患者术后3个月MoCA评分[（26．02±2．9）分]和相对脑血容量（1．00±0．08）较术前明显改善[（24．1±2．2）分、0．97±0．08]，差异有统计学意义（氏0．05）。（2）MoCA评分改善明显患者中，术后相对脑血容量、相对脑血流量、相对平均通过时间3项参数值较术前均有显著改善，差异具有统计学意义（P〈0．05）；而在MoCA评分无明显改善患者组中，此3项参数手术前后差异无统计学意义（P〉0．05）。结论颈动脉内膜剥脱术能改善症状性颈动脉狭窄患者的认知功能，这种改变可能与脑血流灌注改善有关。Objective To observe the influence of carotid endarterectomy in cognitive functions of patients with symptomatic carotid stenosis. Methods Forty-three patients admitted to our hospital and performed carotid endarterectomy from February 2013 to August 2014, were enrolled in the study. Cognitive functions of the patients were evaluated by Montreal cognitive function assessment （MoCA） and cerebral blood flow （CBF） by cerebral perfusion CT scan three days before and three months after operation, respectively. According to the MoCA scores after operation, the patients were divided into significant improvement group and non-siguiflcant improvement group, and their cerebral hemodynamics indexes were compared. Results （1） As compared with those before operation （24.1±2.2, 0.97±0.08）, the MoCA scores （26.02±2.9） and relative cerebral blood volumes （rCBV, 1.00±0.08） three months after operation were significantly different （P〈0.05）. （2） The postoperative relative CBF, rCBV and relative mean transmit time in the significant improvement group were significantly improved as compared with those preoperative indexes （P〈0.05）; whereas, these values in the non-significant improvement group didn＇t show significant difference between preoperative and postoperative indexes（P〉0.05）. Conclusion Carotid endarterectomy may help to improve the cognitive function in those patients with symtompatic carotid stenosis, and the effect might be associated with the improvement of cerebral per fusion.

关 键 词：颈动脉内膜剥脱 颈动脉狭窄 认知功能 

分 类 号：R653[医药卫生—外科学]