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颅内介入栓塞与夹闭术对颅内动脉瘤患者认知和神经功能的影响。

Effects of Intracranial Interventional Embolization and Intracranial Clipping on the Cognitive and Neurologic Function of Patients with Intracranial Aneurysms.

机构信息

Department 5 of Neurosurgery, Cangzhou Central Hospital, Cangzhou, Hebei, China.

出版信息

Arch Clin Neuropsychol. 2022 Nov 21;37(8):1688-1698. doi: 10.1093/arclin/acac030.

Abstract

BACKGROUND

Intracranial interventional embolization and intracranial clipping have been two typical therapies for the emergent rescue of intracranial aneurysm. However, there are still controversies over the impact of these two surgical treatments of aneurysms on cognitive and neurological functions of patients.

METHODS

A total of 144 patients with intracranial aneurysms were enrolled as the test subjects, who were randomly and evenly divided into the Intracranial Clipping group and the Interventional Embolization group. Cognitive and neurologic functions were evaluated by Glasgow Outcome Scale, Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE) scales, National Institutes of Health Stroke Scale (NIHSS) and Activities of Daily Living (ADL) scale. Enzyme-linked immunosorbent assay was used to analyze the serum levels of neuron-specific enolase (NSE) and S100β.

RESULTS

There were no significant differences in the preoperative MMSE, MoCA, NIHSS or ADL scale between two groups (p > 0.05). However, after operation, the MMSE and MoCA scores of the interventional embolization group were significantly higher, whereas the NIHSS and ADL scales were significantly lower than those of the intracranial clipping group (p < 0.05). The levels of NSE and S100β in the intracranial clipping group were significantly higher than in the interventional embolization group.

CONCLUSION

Intracranial interventional embolization exerts better effects on the cognitive and neurologic functions than intracranial clipping.

摘要

背景

颅内介入栓塞和颅内夹闭已成为颅内动脉瘤紧急救治的两种典型疗法。然而,对于这两种手术治疗动脉瘤对患者认知和神经功能的影响仍存在争议。

方法

共纳入 144 例颅内动脉瘤患者作为研究对象,随机均分为颅内夹闭组和介入栓塞组。采用格拉斯哥结局量表(GOS)、蒙特利尔认知评估量表(MoCA)、简易智力状态检查量表(MMSE)、美国国立卫生研究院卒中量表(NIHSS)和日常生活活动量表(ADL)评估认知和神经功能。酶联免疫吸附试验(ELISA)分析血清神经元特异性烯醇化酶(NSE)和 S100β 水平。

结果

两组患者术前 MMSE、MoCA、NIHSS 或 ADL 量表无显著差异(p>0.05)。但介入栓塞组术后 MMSE 和 MoCA 评分明显高于颅内夹闭组,而 NIHSS 和 ADL 评分明显低于颅内夹闭组(p<0.05)。颅内夹闭组 NSE 和 S100β 水平明显高于介入栓塞组。

结论

颅内介入栓塞对认知和神经功能的影响优于颅内夹闭。

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