摘要
目的:探讨颈动脉狭窄患者在行颈动脉支架置入术后认知功能的变化情况,并分析CT灌注成像(CTP)对手术疗效的评估价值。方法:选取2015年10月到2018年3月在济宁医学院附属日照市人民医院接受治疗的颈动脉狭窄患者80例,其中有症状性颈动脉狭窄患者49例作为有症状组,无症状性颈动脉狭窄患者31例作为无症状组。所有患者均接受颈动脉支架置入手术及CTP检查,采用蒙特利尔认知评估量表(MoCA)、简易智能精神状况量表(MMSE)、搭火柴测验(Stick Test)综合评价颈动脉狭窄患者的术前、术后1周、术后3个月、术后6个月认知功能的变化情况,比较有症状组和无症状组患者的CTP相对灌注参数。结果:术后1周,颈动脉狭窄患者的MoCA总分、视空间/执行能力、注意力、延迟回忆以及MMSE总分、Stick Test总分较术前有所降低(P<0.05);术后3个月、术后6个月,颈动脉狭窄患者的MoCA总分、视空间/执行能力、注意力、延迟回忆以及MMSE总分、Stick Test总分较术前有所升高(P<0.05)。术前,有症状组的相对血流达峰时间、相对平均通过时间长于无症状组,相对脑血流量低于无症状组(P<0.05);术后1周,无症状组的相对血流达峰时间较术前有所缩短,且短于有症状组(P<0.05);术后1周,有症状组的相对血流达峰时间、相对平均通过时间较术前有所缩短,相对脑血流量较术前有所升高(P<0.05);两组术前、术后1周相对脑血容量比较均无统计学差异(P>0.05)。结论:颈动脉支架置入术后患者会出现暂时的、可逆的认知功能恶化,但最终认知功能会得到明显的改善。CTP可发现异常的脑灌注情况,同时能够较好地评价颈动脉支架置入术治疗颈动脉狭窄患者的疗效。
Objective: To investigate the changes of cognitive function in patients with carotid stenosis after carotid artery stenting,and to evaluate the value of CT perfusion(CTP) imaging in evaluating the curative effect. Methods: 80 patients with carotid stenosis who underwent treatment in Rizhao People’s Hospital Affiliated to Jining Medical College from October 2015 to March 2018 were enrolled.Among them,49 patients with symptomatic carotid stenosis were treated as symptomatic group, and 31 patients with asymptomatic carotid stenosis were treated as asymptomatic group. All patients underwent carotid artery stenting and CTP examination, the Montreal Cognitive Assessment Scale(MoCA), Simple Mental State Scale(MMSE) and Stick Test were used to evaluate the changes of cognitive function in patients with carotid stenosis before operation, 1 week, 3 months and 6 months after operation. The CTP relative perfusion parameters were compared between the symptomatic group and the asymptomatic group. Results: 1 week after operation, the total scores of Mo CA, visual space/executive ability, attention, delayed memory, MMSE and Stick Test in patients with carotid artery stenosis were lower than those before operation(P<0.05). The total scores of MoCA,visual space/executive ability, attention, delayed memory, MMSE and Stick Test in patients with carotid artery stenosis were higher than those at 3 months after operation and 6 months after operation(P<0.05). Before operation, the relative peak time and the relative average transit time of the symptomatic group were longer than those of the asymptomatic group, relative cerebral blood flow were lower in the asymptomatic group(P<0.05). 1 week after operation,the peak time of relative blood flow in the asymptomatic group were shorter than that before operation, and were shorter than that in the symptomatic group(P<0.05). 1 week after operation, the relative peak time and the relative average transit time of the symptomatic group were shorter than those before operation, and the relative cerebral blood flow were higher than that before operation(P<0.05). There was no significant difference in the relative cerebral blood volume between the two groups before operation and 1 week after operation(P>0.05). Conclusion: Patients with carotid stenting may experience temporary, reversible cognitive deterioration,but the cognitive function will be significantly improved.CTP can detect abnormal cerebral perfusion, and can better evaluate the efficacy of carotid stent placement in patients with carotid stenosis.
作者
李建龙
杨芳
孔凡斌
刘学军
徐文坚
LI Jian-long;YANG Fang;KONG Fan-bin;LIU Xue-jun;XU Wen-jian(Department of Neurology,Rizhao People's Hospital Affiliated to Jining Medical College,Rizhao,Shandong,276800,China;Department of Radiology,The Affiliated Hospital of Qingdao University,Qingdao,Shandong,266003,China)
出处
《现代生物医学进展》
CAS
2019年第19期3744-3747,共4页
Progress in Modern Biomedicine
基金
山东省医药卫生科技发展计划项目(2015WS1227)
济宁医学院青年教师科研扶持基金(JY2016KJ017Z)
关键词
颈动脉支架置入术
狭窄
CT灌注成像
认知
疗效
Carotid artery stenting
Carotid stenosis
CT perfusion imaging
Cognitive
Curative effect
