摘要： 目的 探讨颞浅动脉-大脑中动脉（STA-MCA）搭桥术联合脑-颞肌贴敷术（EMS）对烟雾病患者认知功能的改善作用。方法 纳入2017年7月至2020年6月在天津医科大学总医院行STA-MCA搭桥术+EMS的37例烟雾病患者，分别于术前1周和术后6个月采用简易智能状态检查量表（MMSE）评估整体认知功能、听觉词汇学习测验（AVLT）评估记忆力、连线测试A （TMT-A）评估注意力、连线测试B （TMT-B）评估执行功能、词语流畅性测验（VFT）评估语言功能、Rey-Osterrieth复杂图形测验（ROCFT）评估视空间能力。结果 与术前1周相比，术后6个月时MMSE[24（23，26）分对25.00（23.50，27.00）分；Z=-4.201，P=0.000]和ROCFT[28（23，30）分对31.00（28.50，32.00）分；Z=-3.968，P=0.004]评分增加，TMT-A[69.00（56.00，87.50） s对42（37，48） s；Z=-5.144，P=0.002]和TMT-B[177（168，190） s对138（133，144） s；Z=-5.309，P=0.001]完成时间缩短；手术前后AVLT-1R （Z=-1.595，P=0.113）、AVLT-5R （Z=-1.573，P=0.121）和VFT （Z=-1.616，P=0.124）评分差异无统计学意义。结论 STA-MCA搭桥术+EMS可以改善烟雾病患者整体认知功能、注意力、执行功能和视空间能力，而对短时记忆、长时记忆和语言功能无明显作用，可以一定程度改善认知功能，提高生活质量。

关键词: 脑底异常血管网病, 脑血管重建术, 认知障碍, 神经心理学测验

Abstract: Objective To evaluate the improvement of superficial temporal artery-middle cerebral artery (STA-MCA) bypass combined with encephalo-myo-synangiosis (EMS) on cognitive function in patients with moyamoya disease (MMD). Methods Total 37 patients with MMD treated with STA-MCA + EMS in Tianjin Medical University General Hospital from July 2017 to June 2020 were reviewed. Mini-Mental State Examination (MMSE), Auditory Verbal Learning Test (AVLT), Trail Making Test-A (TMT-A), Trail Making Test-B (TMT-B), Verbal Fluency Test (VFT) and Rey-Osterrieth Complex Figure Test (ROCFT) were used to evaluate overall cognitive function, memory, attention, executive function, language function and visuospatial function in all patients one week before surgery and 6 months after surgery. Results Compared with one week before surgery, the MMSE score[24 (23, 26) score vs. 25.00 (23.50, 27.00) score; Z=-4.201, P=0.000] and ROCFT score[28 (23, 30) score vs. 31.00 (28.50, 32.00) score; Z=-3.968, P=0.004] increased, while the TMT-A test[69.00 (56.00, 87.50) s vs. 42 (37, 48) s; Z=-5.144, P=0.002] and TMT-B test[177 (168, 190) s vs. 138 (133, 144) s; Z=-5.309, P=0.001] decreased at 6 months after surgery. There was no statistic difference of AVLT-1R (Z=-1.595, P=0.113), AVLT-5R (Z=-1.573, P=0.121) and VFT (Z=-1.616, P=0.124) before and after surgery. Conclusions STA-MCA + EMS can improve the overall cognitive function, attention, executive function and visuospatial ability of patients with MMD, but has no significant effect on short-term memory, long-term memory and language function, and can improve cognitive function and the quality of life.

Key words: Moyamoya disease, Cerebral revascularization, Cognition disorders, Neuropsychological tests