Sándor Ágnes Dóra, Sikos Péter Márk, Varinot Gabriel, Kallinikos Fotis, Mánfai Csongor, Ifju Mandula, Kézi Tibor, Czinege Zsófia, Szabó András, Mihály Zsuzsanna, Sótonyi Péter, Székely Andrea
Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary.
Master's Program in Autonomous Systems, Faculty of Informatics, Eötvös Loránd University, 1053 Budapest, Hungary.
Biomedicines. 2025 Sep 7;13(9):2188. doi: 10.3390/biomedicines13092188.
: Long-term cognitive outcomes after carotid surgery are influenced by diabetes and intraoperative changes. We aimed to analyze the postoperative cognitive changes in diabetic patients and nondiabetic patients after carotid endarterectomy (CEA). Additionally, major cardiovascular and cerebrovascular events (MACCEs) and the incidence of mortality at two years after surgery were assessed. : We enrolled 37 diabetic and 67 nondiabetic patients undergoing elective carotid surgery. Intraoperatively, routine monitoring was completed with NIRS (near-infrared spectroscopy) and an Entropy monitor was used for neuromonitoring. The lowest cerebral tissue saturation levels during the cross-clamp period (rSO) and the degree of desaturation were calculated. We used MMSE (Mini-Mental State Examination) and MoCA (Montreal Cognitive Assessment) to assess cognitive function. Cognitive change was defined as one standard deviation (SD) change from the preoperative test scores. : The MMSE and MoCA were available for 103 patients at three months and for 90 patients at 12 months after discharge. Compared with nondiabetic patients, diabetic patients exhibited greater decreases in MoCA scores ( = 0.028 and = 0.042 at the 3rd and 12th months, respectively). Cognitive improvement was lower in the DM group than in the control group at the 12th month (18.75% vs. 42.86%, respectively; = 0.029). The mean rSO in the pre-clamping period (67.4% vs. 74.6% in diabetic and in nondiabetic patients, respectively; = 0.011) was lower in diabetic patients. Furthermore, MACCEs at the 24th month were observed at a higher rate in diabetic patients ( = 0.040). : Diabetic patients demonstrated greater risks for cognitive decline, MACCEs, and mortality at two years after surgery.
颈动脉手术后的长期认知结果受糖尿病和术中变化的影响。我们旨在分析颈动脉内膜切除术（CEA）后糖尿病患者和非糖尿病患者的术后认知变化。此外，还评估了主要心血管和脑血管事件（MACCEs）以及术后两年的死亡率。
我们纳入了37例接受择期颈动脉手术的糖尿病患者和67例非糖尿病患者。术中，使用近红外光谱（NIRS）完成常规监测，并使用熵监测仪进行神经监测。计算交叉夹闭期间最低脑组织饱和度水平（rSO）和去饱和程度。我们使用简易精神状态检查表（MMSE）和蒙特利尔认知评估量表（MoCA）评估认知功能。认知变化定义为与术前测试分数相比有一个标准差（SD）的变化。
出院后3个月时，103例患者可进行MMSE和MoCA评估；12个月时，90例患者可进行评估。与非糖尿病患者相比，糖尿病患者的MoCA评分下降幅度更大（第3个月和第12个月时分别为P = 0.028和P = 0.042）。在第12个月时，糖尿病组的认知改善低于对照组（分别为18.75%和42.86%；P = 0.029）。糖尿病患者夹闭前的平均rSO较低（糖尿病患者和非糖尿病患者分别为67.4%和74.6%；P = 0.011）。此外，糖尿病患者在第24个月时发生MACCEs的比例更高（P = 0.040）。
糖尿病患者在术后两年出现认知下降、MACCEs和死亡的风险更高。
