老年急性脑梗死患者梗死部位与执行功能关系分析

Relationship between infarction site and executive function in elderly acute cerebral infarction patients

目的探讨不同部位脑梗死对老年急性脑梗死患者执行功能的影响。方法选取2019年10月~2020年6月成都市第三人民医院神经内科住院的老年急性脑梗死患者198例,排除不符合纳入标准53例,最终纳入145例,根据梗死部位分为皮质梗死组(A组)42例,皮质下梗死组(B组)54例,小脑和(或)脑干梗死组(C组)21例,多区域梗死组(D组)28例。利用蒙特利尔认知评估量表(MoCA)评价总体认知功能,采用Stroop色词测验(SCWT)和连线测验(TMT)评估患者执行功能。结果B组MoCA总分及视空间与执行评分明显高于D组,差异有统计学意义[(21.11±4.69)分vs(17.86±4.74)分,P<0.05,(2.89±1.44)分vs(1.86±1.15)分,P<0.01]。A组TMT-A耗时明显大于B组及C组[189.27(114.73,330.94)s vs 108.76(70.81,175.74)s,101.11(67.72,129.39)s,P<0.01],TMT-B耗时明显大于B组,差异有统计学意义[426.79(272.02,765.82)s vs 300.63(215.91,545.09)s,P<0.05]。B组TMT-B耗时明显小于D组[300.63(215.91,545.09)s vs 424.89(292.79,919.61)s,P<0.05]。B组C正确数明显高于A组和D组,C耗时、正确数(B-C)/A、SIE正确数(B-C)、C耗时/正确数明显少于A组和D组,差异有统计学意义(P<0.05,P<0.01),A组SIE耗时数(C-B)明显高于B组,差异有统计学意义(P<0.05)。结论老年急性脑梗死中,皮质梗死和多区域梗死患者执行功能受损更为明显,多区域梗死患者总体认知水平较低。

Objective To study the effect of different cerebral infarction sites on executive function in elderly acute cerebral infarction(ACI)patients.Methods One hundred and forty-five elderly ACI patients admitted to Chengdu No.3 People’s Hospital from October 2019 to June 2020 were divided into cortical infarction group or group A(n=42),subcortical infarction group or group B(n=54),cerebellar and/or brain stem infarction group or group C(n=21),and multiregional infarction group or group D(n=28).Their global cognitive function was assessed according to the Montreal cognitive scale(MoCA).Their executive function was assessed according to the Stroop color word test(SCWT)and the trail making test(TMT)respectively.Results The total MoCA score,visual space score and execution score were significantly higher in group B tnan in group D(21.11±4.69 vs 17.86±4.74,P<0.05;2.89±1.44 vs 1.86±1.15,P<0.01).The consuming time of TMT-A was significantly longer in group A than in groups B and C[189.27(114.73,330.94)s vs 108.76(70.81,175.74)s and 101.11(67.72,129.39)s,P<0.01]while that of TMT-B was significantly longer in group A than in group B[426.79(272.02,765.82)s vs 300.63(215.91,545.09)s,P<0.05]and was significantly shorter in group B than in group D[300.63(215.91,545.09)s vs 424.89(292.79,919.61)s,P<0.05].The SCWT correct number of card C was significantly larger while the consuming time of card C was significantly shorter,the correct number of(B-C)/A,SIE(B-C)and card C was significantly smaller in group B than in groups A and D(P<0.05,P<0.01).Conclusion The executive function impairment is severer in cortical and multiregional infarction patients while the global cognitive function is poorer in multiregional infarction patients.