症状性颈动脉狭窄支架植入术影响认知功能的功能影像学研究

发布时间：2018-07-04 13:25

本文选题：颈动脉狭窄 + 认知功能　；参考：《浙江大学》2014年硕士论文

【摘要】：目的：进一步验证症状性粥样硬化性颈内动脉狭窄支架植入术对认知功能的影响,探讨手术前后脑灌注状态与认知功能改变之间的关系。方法：采用多种认知评估量表(简明精神状态量表、手指敲击试验、连线试验、韦氏成人记忆量表)对21例单侧症状性粥样硬化性颈内动脉狭窄患者支架植入术前、术后6个月认知功能进行评估。同时采用CT全脑灌注扫描评价支架植入术前、术后患者脑灌注状态。结果： 21例患者均成功植入自膨式颈动脉支架。与支架植入术前相比,21例患者术后6个月总体认知功能水平(MMSE得分)无显著性改变,但执行功能(手指敲击试验得分)、注意力(连线试验得分)以及记忆力(韦氏成人记忆量表得分)均显著改善,差异具有统计学意义。根据全脑CT灌注扫描结果将患者分为低灌注组与非低灌注组。与非低灌注组患者相比,低灌注组患者术前总体认知功能水平(MMSE得分)、执行功能(手指敲击试验得分)明显较差,差异具有统计学意义。支架植入术后低灌注组患者总体认知功能水平(MMSE得分)无显著性改变,而执行功能(手指敲击试验得分)、注意力(连线试验得分)以及记忆力(韦氏成人记忆量表得分)均有显著性提高。非低灌注组患者术后各项认知功能均无显著性改变。结论：粥样硬化性颈内动脉狭窄可导致大脑低灌注,从而引起认知功能障碍。颈动脉支架植入术可以有效改善伴有大脑低灌注的粥样硬化性颈内动脉狭窄引起的认知功能损害。
[Abstract]:Aim: to investigate the effect of stent implantation on cognitive function in patients with symptomatic atherosclerotic internal carotid artery stenosis and to explore the relationship between cerebral perfusion status and cognitive function before and after operation. Methods: 21 patients with unilateral symptomatic internal carotid artery stenosis were treated with multiple cognitive assessment scales (brief mental state scale, finger tapping test, wired test, Wechsler adult memory scale) before stenting. Cognitive function was evaluated 6 months after operation. At the same time, CT whole brain perfusion scan was used to evaluate the cerebral perfusion status before and after stent implantation. Results: self-expandable carotid stents were successfully implanted in 21 patients. There was no significant change in total cognitive function (MMSE) in 21 patients 6 months after operation compared with that before stent implantation. However, the executive function (finger tapping test score), attention (wired test score) and memory (Wechsler adult memory scale score) were significantly improved, the difference was statistically significant. Patients were divided into low perfusion group and non-hypoperfusion group according to CT perfusion scan results. Compared with the non-hypoperfusion group, the total cognitive function (MMSE) and the executive function (the finger tapping test score) of the low perfusion group were significantly lower than those of the non-hypoperfusion group, and the difference was statistically significant. There was no significant change in the overall cognitive function (MMSE score) after stent implantation in the low perfusion group. The scores of executive function (finger tapping test), attention (wired test) and memory (Wechsler adult memory scale) were significantly improved. There were no significant changes in cognitive function after operation in non-hypoperfusion group. Conclusion: atherosclerotic internal carotid artery stenosis may lead to cerebral hypoperfusion and cognitive impairment. Carotid stent implantation can effectively improve cognitive impairment caused by atherosclerotic internal carotid artery stenosis with cerebral hypoperfusion.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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