摘要
目的探讨成人烟雾病行颞浅动脉(STA)-大脑中动脉(MCA)搭桥术后脑高灌注综合征(CHS)的临床特点及危险因素.方法回顾性分析2019年8月至2022年9月哈尔滨医科大学附属第一医院神经外科采用STA-MCA搭桥术联合颞肌贴敷或颅骨多点钻孔方法治疗的213例成人烟雾病患者的临床资料.根据患者术后14 d是否出现CHS,分为CHS组和非CHS组.术后3个月根据改良Rankin量表评分(mRS)评估患者的临床预后.采用单因素分析和多因素logistic回归模型分析方法探讨烟雾病患者STA-MCA搭桥术后发生CHS的危险因素.结果213例患者中,术后35例(16.4%)出现CHS,其中脑出血5例(14.3%),局灶性癫痫发作6例(17.1%),短暂性神经功能障碍24例(68.6%).术后3个月,mRS0~2分202例,3~6分11例.CHS组的mRS[M(Q_(1),Q_(3))]为1(0,1)分,其中0~2分者占94.3%(33/35);非CHS组的mRS[M(Q_(1),Q_(3))]为1(0,1)分,其中0~2分者占94.9%(169/178),两组的差异无统计学意义(χ^(2)=0.59,P=0.441).单因素分析结果显示,CHS组与非CHS组患者的原发性高血压、首发症状为脑出血、术侧铃木分期为晚期(Ⅳ~Ⅵ期)以及术前血清红细胞压积的差异均有统计学意义(均P<0.05).多因素logistic回归模型分析结果显示,合并原发性高血压(OR=3.69,95%CI:1.52~9.00,P=0.004)、首发症状为脑出血(OR=3.21,95%CI:1.08~9.54;P=0.036)、术前血清红细胞压积水平较高(OR=1.17,95%CI:1.06~1.29,P=0.002)均为烟雾病患者行STA-MCA搭桥术后出现CHS的危险因素.结论成人烟雾病患者行STA-MCA搭桥术后发生的CHS多表现为短暂性神经功能障碍,患者术后3个月的预后与未发生CHS的患者无明显差异.合并原发性高血压、首发症状为脑出血、术前血清红细胞压积水平较高的成人烟雾病患者行STA-MCA搭桥术后更易发生CHS.
Objective To explore the clinical characteristics and risk factors of cerebral hyperperfusion syndrome(CHS)after superficial temporal artery-middle cerebral artery(STA-MCA)bypass surgery in adults with moyamoya disease.Methods A retrospective analysis was performed on the clinical data of 213 adult patients with moyamoya disease treated by STA-MCA bypass combined with temporalis muscle taping or multi-point drilling in the skull at the Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University from August 2019 to September 2022.According to whether patients developed CHS 14 days after surgery,they were divided into CHS group and non-CHS group.The clinical outcome of the patients was evaluated based on the modified Rankin Scale score(mRS)3 months after surgery.Univariate analysis and multivariate logistic regression model analysis methods were used to explore the risk factors for CHS after STA-MCA bypass surgery in patients with moyamoya disease.Results Among 213 patients,35 cases(16.4%)developed CHS after surgery,including 5 cases(14.3%)of cerebral hemorrhage,6 cases(17.1%)of focal epileptic seizures,and 24 cases(68.6%)of transient neurological dysfunction.Three months after surgery,202 cases had mRS scores of 0 to 2 points,and 11 cases had mRS scores of 3 to 6 points.Three months after surgery,the mRS of the CHS group was 1(0,1),of which 94.3%(33/35)were 0 to 2;the mRS of the non-CHS group was 1(0,1),of which 94.9%(169/178)scored 0 to 2 points,and the difference between the two groups was not statistically significant(χ^(2)=0.59,P=0.441).The results of univariate analysis showed that there were statistically significant differences between the CHS group and the non-CHS group in terms of history of hypertension,cerebral hemorrhage as the first symptom,advanced Suzuki stage on the surgical side(stagesⅣtoⅥ),or preoperative serum hematocrit(all P<0.05).Multivariate logistic regression analysis showed that patient's history of hypertension(OR=3.69,95%CI:1.52-9.00,P=0.004),cerebral hemo
作者
姚金彪
陈平伯
郑秉杰
吴桥伟
李俞辰
徐东晓
陈爱霞
史怀璋
Yao Jinbiao;Chen Pingbo;Zheng Bingjie;Wu Qiaowei;Li Yuchen;Xu Dongxiao;Chen Aixia;Shi Huaizhang(Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2024年第6期575-580,共6页
Chinese Journal of Neurosurgery
基金
国家自然科学基金(82101383)
黑龙江省自然科学基金(YQ2019H05)
中国博士后科学基金面上项目(2021MD703829)。
关键词
脑底异常血管网病
脑血管重建术
疾病特征
危险因素
脑高灌注综合征
Moyamoya disease
Cerebral revascularization
Disease attributes
Risk factors
Cerebral hyperperfusion syndrome
