相位对比磁共振成像定量评估烟雾病患者血管重建术前后血流动力学

目的采用相位对比磁共振成像(phase-contrast magnetic resonance imaging,PC-MRI)评估烟雾病患者脑血管重建术术前及术后6个月时的血流动力学,分析术后发生脑过度灌注综合征(cerebral hyperperfusion syndrome,CHS)的危险因素。方法回顾性纳入2017年1月至2019年4月在复旦大学附属华东医院接受联合血管重建术的烟雾病患者。在术前及术后6个月行PC-MRI检查,记录颈内动脉、颈外动脉、颞浅动脉和椎动脉的血流速度、血流量以及血管管腔感兴趣区(regions of interest,ROI)面积。应用多变量logistic回归分析确定CHS的独立相关因素。结果共纳入80例烟雾病患者,男性35例(43.75%),年龄(42.4±10.1)岁(范围19~60岁)。术后6个月时颞浅动脉血流速度(P<0.05)、血流量(P<0.01)及ROI面积(P<0.01)均较术前显著增加,而椎动脉血流量变慢(P<0.05)。单变量分析显示,伴有糖尿病、优势半球侧手术、术前颞浅动脉血流速度加快、颈内动脉流量变小以及颈外动脉流量升高是烟雾病患者术后发生CHS的可能危险因素。多变量分析显示,优势半球侧手术[优势比(odds ratio,OR)4.627,95%可信区间(confidence internal,CI)1.019~21.009;P=0.047]、术前颞浅动脉血流量(OR 1.208,95%CI 1.053~1.387;P=0.007)和颈外动脉血流量(OR 0.139,95%CI 0.027~0.719;P=0.019)与术后CHS独立相关。结论PC-MRI能评估颅内外主要血管血流动力学参数,并可作为评价烟雾病术后风险的重要依据之一。

Memory and behavior-related problems of patients with neurocognitive disorders and the attitudes of their caregivers

Objective:The purpose of this study was to investigate the memory and behavior-related problems of patients with neurocognitive disorders and the attitudes of their caregivers so as to provide an effective basis for nursing interventions against such problems.Methods:The subjects were selected from patients who were under treatment or short-term hospitalization between April 2011 and March 2012.One hundred fifty-three patients with neurocognitive disorders and their major caregivers were selected from 9 grade 3 Class A hospitals of Hunan Province.The Revised Memory and Behavior Problems Checklist(RMBPC)was used to measure the memory and behavior-related problems of patients with neurocognitive disorders and the influence on their caregivers.The occurrence of different memory and behavior-related prob-lems and the distress on their caregivers was compared.Results:The RMBPC investigation showed that among 153 patients and their caregivers,152(99.3%)had memory-related problems,137(89.5%)had depression,and 136 patients(88.9%)had destructive behaviors.The incidence of memory-related problems was higher than depression and destructive behaviors(P<0.01).Caregivers bore more distress when encountering destructive behaviors(1.95±1.13 points)than memory-related problems and depression(0.91±0.76 points and 0.89±0.85 points;P<0.01).Curve fitting was used to analyze the relationship between the number of memory and behavior-related problems and the distress on their caregivers.A curve correlation existed between the two factors(the recorded maximum value of the Cubic equation curve was 0.278,F=229.212,P<0.05).Conclusion:Among patients with neurocognitive disorders,memory-related problems had the highest incidence,while the caregivers bore the strongest distress when encountering destructive behaviors,thus interventions should be conducted in consideration of patient memory and behavior-related problems,and caregivers’attitude to further reduce caregiver burden.