Neuropsychometric changes in patients after carotid endarterectomy
Neuropsychometric changes in patients after carotid endarterectomy
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DOI：
10.1161/01.str.29.6.1110
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发表时间：
1998-06-01
期刊：
影响因子：
8.3
通讯作者：
Connolly, ES
中科院分区：
文献类型：
--
作者：
Heyer, EJ;Adams, DC;Connolly, ES
背景和目的：112例因有症状和无症状性颈动脉狭窄而行选择性颈动脉内膜切除术的患者参加了一项前瞻性研究，以评估术后脑功能改变的发生率。方法对患者在出院前、术后、1个月和5个月后进行一系列神经心理测试。对结果进行事故率和组率分析。对于事件发生率分析，变化被定义为术后神经心理测量能力与术前基线相比下降或改善25%或更多。结果：大约80%的患者在一项或多项测试分数上表现出下降，60%的患者在第一次随访检查中有一项或多项测试分数的改善。随着后续检查的进行，考试成绩下降的百分比减少，考试成绩提高的百分比增加。在个体测试中，群体表现的群体比率分析类似。然而，在言语记忆测试中表现最差，而在执行和运动测试中表现最好。结论--对接受颈动脉内膜切除术的患者进行的神经心理测评显示，神经心理测评既有下降，又有改善。检查结果显示性能下降可能与整体低灌注率或栓子现象引起的缺血有关，而改善则可能与狭窄解除后脑血流量增加有关。
Background and Purpose-One hundred twelve patients undergoing elective carotid endarterectomy for symptomatic and asymptomatic carotid artery stenosis were enrolled in a prospective study to evaluate the incidence of change in postoperative cerebral function.Methods-Patients were evaluated preoperatively and postoperatively before hospital discharge and at follow-up 1 and 5 months later with a battery of neuropsychometric tests. The results were analyzed by both event-rate and group-rate analyses. For event-rate analysis, change was defined as either a decline or improvement in postoperative neuropsychometric performance by 25% or more compared with a preoperative baseline.Results-Approximately 80% of patients showed decline in one or more test scores, and 60% had one or more improved test scores at the first follow-up examination. The percentage of declined test scores decreased and the percentage of improved test scores increased with subsequent follow-up examinations. Group-rate analysis was similar for group performance on individual tests. However, a decline in performance was seen most commonly on verbal memory tests, and improved performance was seen most commonly on executive and motor tests.Conclusions-Neuropsychometric evaluation of patients undergoing carotid endarterectomy for significant carotid artery stenosis demonstrates both declines and improvements in neuropsychometric performance. The test changes that showed decreased performance may be associated with ischemia from global hypoperfusion or embolic phenomena, and the improvement seen may be related to increased cerebral blood flow from removal of stenosis.