颈动脉支架成形术对aCAS患者脑血流动力学及认知功能的影响  

Effects of Carotid Artery Stenting on Cerebral Hemodynamics and Cognitive Function in aCAS Patients

作　　者：李冬松 敖金江 王宁 屈铭芳 郜锦英 

机构地区：[1]安康市人民医院神经内科,陕西安康725000

出　　处：《华南国防医学杂志》2018年第1期17-19,50,共4页Military Medical Journal of South China

基　　金：国家"十二五"科技支撑计划子项目(2011BAI08B07)

摘　　要：目的探讨并分析颈动脉支架成形术对无症状性颈动脉狭窄(asymptomatic carotid artery stenosis,aCAS)(狭窄>70.0%)患者脑血流动力学及认知改善的影响。方法选取2014-05/2017-05月作者医院收治的100例aCAS患者,行颈动脉支架植入术。在支架植入术前1周内及植入术后3个月采用经颅多普勒超声(transcranial Doppler ultrasound,TCD)检测手术前后收缩期峰值血流速度(peak systolic blood flow velocity,PSV)、搏动指数(pulsatility index,PI)及脑血管储备能力(cerebrovascular reserve capacity,CVR)。观察并记录阿尔茨海默病评估量表-认知分表(Alzheimer's disease assessment scale-cognitive subscale,ADAS-Cog)、简易智能量表(mini-mental state examination,MMSE)、连线测验A(trail making test-A,TMTA)、连线测验B(trail making test-B,TMTB)评分。并按照侧枝循环开放程度将患者分为完全开放、不完全开放型比较所有患者手术前后aCAS患者脑血流动力学及认知改变。结果患者术后ADAS-Cog、MMSE、TMTA、TMTB评分较术前明显改善,手术前后比较差异具有统计学意义(P<0.05);手术前患者PSV、PI及CVR分别为(57.21±22.41)cm/s、0.65±0.15、(17.93±7.2)%,手术后患者PSV、PI及CVR分别为(97.45±31.54)cm/s、0.91±0.22、(31.43±8.2)%,明显高于术前,手术前后比较差异具有统计学意义(P<0.05);完全开放、不完全开放型患者术后PSV、PI及CVR均明显高于手术前,手术前后比较差异具有统计学意义(P<0.05),而不完全开放型患者术后PSV、PI及CVR升高程度明显大于完全开放型,二者比较差异具有统计学意义(P<0.05)。结论颈动脉支架能有效改善aCAS患者脑血流动力学,提高患者认知功能。Objective To investigate and analyze the effects of carotid artery stenting on cerebral hemodynamics and cognitive function in patients with asymptomatic carotid artery stenosis（aCAS）（stenosis70.0%）.Methods A total of 100 aCAS patients were selected from May 2014 to May 2017,and treated with carotid artery stenting.The peak systolic blood flow velocity（PSV）,pulsatility index（PI）and cerebrovascular reserve capacity（CVR）were measured by transcranial Doppler ultrasound（TCD）at 1 week before surgury and 3 months after.Alzheimer＇s disease assessment scalecognitive subscale（ADAS-Cog）,mini-mental state examination（MMSE）,trail making test-A（TMTA）and trail making test-B（TMTB）scores were observed and recorded.Based on the degree by the opening of collateral circulation,the patients were divided into complete open group and incomplete open group.The hemodynamic changes and cognitive changes of aCAS patients before and after operation were compared.Results The postoperative ADAS-Cog,MMSE,TMTA and TMTB scores were obviously improved（P〈0.05）.The preoperative levels of PSV,PI and CVR were clearly higher than postoperative levels of them [（57.21±22.41）cm/s vs.（97.45±31.54）cm/s,（0.65±0.15）vs.（0.91±0.22）,（17.93±7.2）% vs.（31.43±8.2）%,P〈0.05].The postoperative levels of PSV,PI and CVR in both complete open group and incomplete open group were significantly higher than preoperative levels of them（P〈0.05）,the degrees of increasement in the incomplete open group were much more than these in the complete open group（P〈0.05）.Conclusion Carotid artery stenting can effectively improve cerebral hemodynamics in aCAS patients and enhance cognitive function,it is worthy clinical promotion.

关 键 词：颈动脉支架 认知功能 颈动脉狭窄 脑血流 

分 类 号：R543.4[医药卫生—心血管疾病]