症状性动脉粥样硬化性大脑中动脉重度狭窄支架术对认知功能的影响
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摘要
目的对术前mRS评分0～2分伴有认知功能障碍的症状性动脉粥样硬化性大脑中动脉M1段重度狭窄患者进行支架置入治疗,对其术后认知功能障碍的改善情况进行观察及评价。方法选取30例术前mRS评分0～2分的伴有认知功能障碍的症状性动脉粥样硬化性大脑中动脉M1段重度狭窄患者进行研究,随机分为两组,分别予1个月以上的强化药物治疗及在此基础上行大脑中动脉M1段支架置入术,对30例患者的初始认知功能障碍和入组3个月(即支架术后2个月)的认知功能障碍情况分别进行随访评价。结果药物+支架置入治疗的患者认知功能障碍改善情况与单纯药物治疗比较差异有统计学意义(P<0.05)。结论对于症状性动脉粥样硬化性大脑中动脉M1段重度狭窄患者的药物治疗是基础和必须的,对改善患者认知功能障碍是有帮助的,在此基础上的大脑中动脉重度狭窄处的支架置入治疗对认知功能障碍的改善更加具有可靠的疗效,其长期效果有待进一步研究。
引文
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[3] 张彦红,梁伟雄,朱磊,等.蒙特利尔认知评估量表与简易精神状态量表用于筛查血管性认知障碍的比较[J].中国康复医学杂志,2012,27(5):431-436.
[4] 贾阳娟,韩凝,王美蓉,等.MoCA与MMSE在急性缺血性卒中后认知障碍评估中的应用[J].中华行为医学与脑科学杂志,2017,26(1):46-50.
[5] Wang W,Jiang B,Sun H,et al.Prevalence,Incidence,and Mortality of Stroke in China:Results from a Nationwide Population-Based Survey of 480687 Adults[J].Circulation,2017,135(8):759-771.
[6] Chimowitz MI,Lynn MJ,Derdeyn CP,et al.Stenting versus aggressive medical therapy for intracranial arterial stenosis[J].N Engl J Med,2011,365(11):993-1003.
[7] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国头颈部动脉粥样硬化诊治共识[J].中华神经科杂志,2017,50(8):572-578.
[8] Miao Z,Liebeskind DS,Lo W,et al.Fractional flow assessment for the evaluation of intracranial atherosclerosis:a feasibility study[J].Interv Neurol,2016,5(1/2):65-75.
[9] 袁俊亮,李譞婷,王双坤,等.脑小血管病与认知功能障碍[J].中华行为医学与脑科学杂志,2018,27(3):285-287.
[10] Ghogawala Z,Amin-Hanjani S,Curran J,et al.The effect of carotid endarterectomy on cerebral blood flow and cognitive function[J].J Stroke Cerebrovasc Dis,2013,22(7):1029-1037.
[11] Kernan WN,Ovbiagele B,Black HR,et al.Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45(7):2160-2236.
[12] Zhou P,Lu Z,Gao P,et al.Efficacy and safety of intensive statin therapy in Chinese patients with atherosclerotic intracranial arterial stenosis:a single-center,randomized,single-blind,parallel-group study with one-year follow-up[J].Clin Neurol Neurosurg,2014,120:6-13.
[13] 李俊,任力杰,韩漫夫,等.抑郁症认知功能损害特点的影像学和事件相关电位研究[J].中华行为医学与脑科学杂志,2013,22(11):985-988.
[14] Kim JM,Stewart R,Kang HJ,et al.A prospective study of statin use and poststroke depression[J].J Clin Psychopharmacol,2014,34(1):72-79.
[15] Gao P,Wang D,Zhao Z,et al.Multicenter Prospective Trial of Stent Placement in Patients with Symptomatic High-Grade Intracranial Stenosis[J].AJNR Am J Neuroradiol,2016,37(7):1275-1280.
[16] 陈娇,赵仁亮,徐艳国,等.短暂性脑缺血发作和轻型卒中患者的认知功能损害研究[J].中华行为医学与脑科学杂志,2016,25(4):338-342.