李文臣　徐子奇

[摘要]目的 探讨颈内动脉重度狭窄或闭塞患者侧支循环代偿对认知功能的影响。 方法 选择2014年1月～2015年12月在我院治疗的颈内动脉重度狭窄或者闭塞的发生缺血性脑血管疾病的患者68例的临床资料进行回顾性分析。采用DSA、MRA检查或者CTA检查患者侧支循环代偿情况，根据患者MRA检查或者CTA检查结果交通支开放情况分为前交通开放组、前交通未开放组，后交通支开放组及后交通支为开放组。根据患者DSA检查结果初级侧支开放组、次级侧支开放组和未开放组。分析前交通支开放、后交通支开放、初级侧支开放及次级侧支开放对患者认知功能的影响。 结果 前交通支开放患者MoCA评分显著高于未开放患者（P<0.01）；前交通开放患者在视空、执行能力、注意与计算、抽象方面对患者认知功能的影响较大，差异有高度统计学意义（P<0.01）。后交通动脉开放与未开放患者MMSE、MoCA评分比较差异无统计学意义（P>0.05）。初级侧支开放与次级侧支开放与未开放患者MMSE、MoCA评分比较无显著差异（P>0.05），认知功能各维度得分差异无统计学意义（P>0.05）。 结论 颈内动脉闭塞或者重度狭窄的前循环动脉开放能够改善患者的认知功能。

[关键词] 颈内动脉；狭窄；闭塞；侧支循环代偿；认知功能

[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-9701（2016）16-0017-04

[Abstract] Objective To explore the effects of compensatory collateral circulation on cognitive function in the patients with severe stenosis or occlusion of internal carotid. Methods Clinical data of 68 patients with ischemic cerebrovascular diseases induced by severe stenosis or occlusion of internal carotid who were treated in our hospital from January 2014 to December 2015 were selected and retrospectively analyzed. DSA， MRA examinations or CTA examination were applied to test the compensatory condition of collateral circulation in the patients. According to the opening of communicating artery from the results of MRA or CTA examination， the patients were divided into the opening of anterior communicating artery group， non-opening of anterior communicating artery group， opening of posterior communicating artery group， and non-opening of posterior communicating artery group. According to the DSA examination results， the patients were divided into the primary collateral opening group， secondary collateral opening group and non-opening group. The effects of opening of anterior communicating artery， opening of posterior communicating artery， primary collateral opening and secondary collateral opening on patients' cognitive function were analyzed. Results MoCA score in the opening of anterior communicating artery group was significantly higher than that in the non-opening group（P<0.01）； the effects of the opening of anterior communicating artery on patients' cognitive functions were more significant in terms of visual-space， executive capacity， attention and calculation， and abstraction， and the differences were statistically significant（P<0.01）. MMSE and MoCA scores compared between the opening of posterior communicating artery group and non-opening group were not significantly different （P>0.05）. MMSE and MoCA scores compared between the primary collateral opening group and the secondary collateral opening group and the non-opening group were not significantly different（P>0.05）. The scores of each dimension of cognitive function were not significantly different （P>0.05）. Conclusion Opening of anterior circulatory artery in the occlusion or severe stenosis of internal carotid is able to improve patients' cognitive function.

[Key words] Internal carotid； Stenosis； Occlusion； Compensatory collateral circulation； Cognitive function

缺血性脑血管病是主要的脑血管疾病，具有较高的致残率及致死率，而颅内动脉狭窄或者闭塞是发生脑血管病的主要因素。我国患者的血管病以颈内血管狭窄为主，尤其是颈内动脉末端，动脉粥样硬化是主要的病因基础。颅内动脉发生狭窄或者闭塞时，可能出现良好的侧支循环，从而不出现或者仅出现小的梗死灶[1-3]。因此测定组织血流量灌注是评估侧支循环效果的唯一方法。我们采用……