大脑功能区病变病人术前认知特点及其影响因素

目的探讨大脑功能区病变病人术前的认知特点及其影响因素,为研究手术中认知功能保护奠定基础。方法收集48例接受唤醒手术的大脑功能区病变病人作为实验组,28名健康成年人作为对照组。实验组术前和对照组分别接受《中国修订韦氏成人智力测验》,统计分析人口学因素、病变因素对功能区病变病人术前智力的影响。结果实验组术前言语智力(VIQ)、操作智力(PIQ)、总体智力(FIQ)皆显著低于对照组(均P0.01)。50岁以上的病人术前PIQ显著低于其他年轻者(均P0.05),文化程度低者VIQ、PIQ、FIQ显著低于文化程度高者(均P0.01)。病变侧位于优势半球者术前VIQ显著低于非优势半球侧(P0.05),病变位于额下区的病人术前VIQ、PIQ、FIQ均显著低于枕区病变病人(均P0.05)。结论脑功能区病变的病人术前多已存在认知功能损害,病人文化程度和年龄对智力测评影响较大,优势半球病变和额下区病变的病人术前认知功能受损更加明显,应在手术时加以重视。

Preoperative cognitive characteristics and their influencing factors in patients with lesions in the eloquent areas

Objective To investigate the preoperative cognitive characteristics and their influencing factors of patients with lesions in the eloquent areas in order to provide a basis for studying the protection of cognitive function in surgery.Methods Forty-eight patients with lesions in the eloquent areas who underwent awake surgery and 28 healthy adults were set as experimental group and control group respectively.Chinese modified Wechsler adult intelligence scale(WAIS-RC) was used in experimental group before surgery and control group respectively.The preoperative effects of demographic factors and lesion factors on the intelligence of patients with lesions in the eloquent areas were analyzed.Results The preoperative verbal intelligence quotient(VIQ),performance intelligence quotient(PIQ),full intelligence quotient(FIQ) of patients in experimental group were significantly lower than those in control group(all P<0.01).The preoperative PIQ of patients with age more than 50 years was significantly lower than that of younger patients(all P<0.05).The preoperative VIQ,PIQ and FIQ of patients with low education level were significantly lower than those of patients with high education level(all P<0.01).The preoperative VIQ of patients with lesions in dominant hemisphere was significantly lower than that of patients with lesions in non dominant hemisphere(P<0.05).The preoperative VIQ,PIQ and FIQ of patients with lesions in the subfrontal region were significantly lower than those of patients with lesions in occipital region(all P<0.05).Conclusions Patients with lesions in the eloquent area usually have cognitive impairments before surgery.The education level and age have greater impact on preoperative intelligence of patients.Patients with lesions in the dominant hemisphere and subfrontal region have more significant cognitive impairments,which should be valued during surgery.