颈动脉内膜斑块切除术在症状性颈动脉中度狭窄治疗中的应用

王育胜 张洪钿 洪映标 钟柱 陈泽鑫 彭辉 陈协宏 蔡洁波 蔡跃豪

【摘要】 目的：探討颈动脉内膜斑块切除术在症状性颈动脉中度狭窄治疗中的应用。方法：选择2019年7月-2021年1月揭阳市人民医院诊治的30例症状性颈动脉中度狭窄行颈动脉内膜斑块切除术的患者进行回顾性研究。比较手术前后患者认知情况、脑血流动力学参数及临床治疗效果。结果：术后患者延迟回忆较术前明显改善，差异有统计学意义（P<0.05）;术前和术后的语言功能、注意力及计算力、即时记忆、定向力评分及MMSE总分比较，差异均无统计学意义（P>0.05）。术后患者的定向力、延迟记忆、抽象思维、命名、视空间/执行能力评分及MoCA总分均较术前明显改善，差异均有统计学意义（P<0.05）;术前和术后的语言、注意评分比较，差异均无统计学意义（P>0.05）。术后1个月患者的RI、PSVICA/PSVCCA、EDV、PSV均较术前明显改善，差异均有统计学意义（P<0.05）。术后，有25例患者脑缺血症状明显改善或消失，有5例患者脑缺血症状有所好转或改善。术后1个月随访，手术成功率100%。结论：颈动脉内膜斑块切除术在症状性颈动脉中度狭窄的治疗中能改善患者的认知功能，提高患者的脑血流动力学参数，临床治疗效果显著，意义重大。

【关键词】 颈动脉内膜斑块切除术 症状性颈动脉中度狭窄 认知功能

The Application of Carotid Endarterectomy in the Treatment of Symptomatic Carotid Artery  Moderate Stenosis/WANG Yusheng， ZHANG Hongtian， HONG Yingbiao， ZHONG Zhu， CHEN Zexin， PENG Hui， CHEN Xiehong， CAI Jiebo， CAI Yuehao. //Medical Innovation of China， 2021， 18（16）： 0-085

[Abstract] Objective： To explore the application of carotid endarterectomy in the treatment of symptomatic carotid artery moderate stenosis. Method： A retrospective study was conducted on 30 patients with symptomatic carotid artery moderate stenosis who underwent carotid endarterectomy in Jieyang People’s Hospital from July 2019 to January 2021. The cognitive status， cerebral hemodynamic parameters and clinical therapeutic effect of the patients were compared before and after surgery. Result： Delayed recall was significantly improved after surgery compared with before surgery， the difference was statistically significant （P<0.05）. Before and after surgery， there were no significant differences in language function， attention and calculation ability， immediate memory， orientation scores and total score of MMSE （P>0.05）. Direction， delayed memory， abstract thinking， nomenclature， visuospatial/executive ability scores and total score of MoCA were significantly improved after surgery， the differences were statistically significant （P<0.05）. There were no significant differences in the language and attention scores before and after surgery （P>0.05）. RI， PSVICA/PSVCCA， EDV and PSV of the patients 1 month after surgery were significantly improved compared with those before surgery， the differences were statistically significant （P<0.05）. After surgery， cerebral ischemia symptoms were significantly improved or disappeared in 25 patients and improved or improved in 5 patients. After 1 month follow-up， the success rate of operation was 100%. Conclusion： Carotid endarterectomy in the treatment of symptomatic carotid artery moderate stenosis can improve the cognitive function of patients， improve the cerebral hemodynamic parameters of patients， clinical treatment effect is significant and significant.

[Key words] Carotid endarterectomy Symptomatic carotid artery moderate stenosis Cognitive function

First-author’s address： Jieyang People’s Hospital， Jieyang 522000， China

doi：10.3969/j.issn.1674-4985.2021.16.020

近年来在我国的居民疾病死亡中脑血管疾病的致残、致死率占第一位，其中缺血性脑卒中占2/3，且呈逐年上升趋势[1]。粥样硬化性颈动脉狭窄为大多数缺血性脑卒中的主要致病因素，有研究表明，颈动脉粥样硬化狭窄是一个慢性进行性的疾病，尽早预防和治疗缺血性脑卒中，可有效提高患者的生存质量[2]。……