Fukunaga Atsushi, Kawase Takeshi, Kashima Haruo, Hashimoto Jun, Uchida Koichi
Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
Neurol Med Chir (Tokyo). 2002 Oct;42(10):419-25; discussion 425-6. doi: 10.2176/nmc.42.419.
Postoperative changes in higher cortical function and cerebral blood flow (CBF) were investigated in patients with unruptured cerebral aneurysms to assess the effect of habitual smoking on the known transient changes after aneurysm surgery. Fifty-six adults with unruptured cerebral aneurysms, including 11 heavy smokers (smoking index > or = 600) and 45 non-smokers, were evaluated using three neuropsychological examinations, the Mini-Mental State Examination, the Maze test, and the Kana-hiroi test, and single photon emission computed tomography to measure CBF before and after surgery. Neuropsychological changes were assessed by reliable change indices to take into account the practice effects. The scores of at least one examination decreased in 15 of 56 patients 1 month after surgery. On the Maze test, five of 11 heavy smokers and five of 45 non-smokers deteriorated after surgery, showing a significant difference (p = 0.018). The CBF in heavy smokers often decreased after surgery, but there was no statistically significant difference in logistic regression. Three months after surgery, the neuropsychological scores of 13 of the 15 deteriorated patients recovered to the preoperative level. Higher cortical function in heavy smokers with unruptured cerebral aneurysms often decreases transiently after operation, compared to non-smokers. Therefore, surgery planning for heavy smokers with unruptured cerebral aneurysms should consider this outcome.
为评估习惯性吸烟对未破裂脑动脉瘤手术后已知短暂变化的影响，对未破裂脑动脉瘤患者术后高级皮质功能和脑血流量（CBF）的变化进行了研究。56例未破裂脑动脉瘤成人患者，包括11例重度吸烟者（吸烟指数≥600）和45例非吸烟者，在手术前后通过三项神经心理学检查（简易精神状态检查表、迷宫测试和假名广井测试）以及单光子发射计算机断层扫描来测量CBF进行评估。通过可靠变化指数评估神经心理学变化，以考虑练习效应。术后1个月，56例患者中有15例至少一项检查的分数下降。在迷宫测试中，11例重度吸烟者中有5例，45例非吸烟者中有5例术后恶化，差异有统计学意义（p = 0.018）。重度吸烟者术后CBF常降低，但逻辑回归分析无统计学显著差异。术后3个月，15例恶化患者中有13例的神经心理学分数恢复到术前水平。与非吸烟者相比，未破裂脑动脉瘤的重度吸烟者术后高级皮质功能常短暂下降。因此，对未破裂脑动脉瘤的重度吸烟者进行手术规划时应考虑这一结果。
