175例烟雾病血管重建术后12例发生脑梗死的危险因素分析  

Risk factor for cerebral infarction in 12 patients after revascularization of 175 patients with Moyamoya disease

作　　者：赵亚妮[1] 栾晓嵘[1] 李海燕[1] ZHAO Yani;LUAN Xiaorong;LI Haiyan(Department of Neurosurgery,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China)

机构地区：[1]山东大学齐鲁医院神经外科

出　　处：《山东大学学报（医学版）》2019年第10期93-100,共8页Journal of Shandong University:Health Sciences

摘　　要：目的探讨烟雾病患者血管重建术后发生脑梗死的危险因素及相应的预防措施。方法回顾性分析175例接受血管重建手术的烟雾病患者临床病例资料,根据术后是否新发脑梗死将其分为阳性组和阴性组,将两组患者人口统计学特征、合并症,术前、术中、术后血压等因素进行单因素、多因素分析,分析烟雾病血管重建术后发生脑梗死的危险因素。结果血管重建术后脑梗死发生率为6.8%(12/175),单因素分析结果显示,阳性组和阴性组患者在年龄、糖尿病及高血压病史、术前收缩压均值、术前舒张压均值及术前近1个月伴有短暂性脑缺血发作差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,合并糖尿病、高血压、术前收缩压高为术后新发脑梗死的独立危险因素(P<0.05)。结论糖尿病、高血压、术前收缩压增高是术后脑梗死的危险因素,建议对上述患者尽早辅以药物进行干预,严格控制血糖、血压水平,术前收缩压控制在正常范围内,术后密切观察病情变化,及时发现脑梗死前兆,给予早期干预,以减少脑梗死的发生。Objective To evaluate the risk factors for cerebral infarction after vascular reconstruction for Moyamoya disease(MMD), and to explore the preventive strategies. Methods The clinical data of 175 MMD patients were retrospectively analyzed and the patients were classified into positive group and negative group according to the occurrence of emerging infarction. Demographic data, comorbidities, and preoperative, intraoperative and postoperative blood pressure were compared. Univariate and multivariate regression analyses were performed to explore the risk factors for cerebral infarction. Results The incidence of cerebral infarction was 6.8%(12/175). Univariate analysis revealed that age, diabetes, hypertension, preoperative mean systolic blood pressure, preoperative mean diastolic blood pressure, and transit ischemic attack were significantly different between the positive and negative groups(P<0.05). Multivariate analysis demonstrated that comorbidity with diabetes and hypertension, and high systolic pressure are independent risk factors for new cerebral infarction after vascular reconstruction for MMD(P<0.05). Conclusion Comorbidity with diabetes and hypertension, and high systolic pressure are independent risk factors for cerebral infarction after vascular reconstruction. Medical intervention is recommended for patients with these risk factors to control the blood sugar and blood pressure and to maintain the preoperative systolic pressure within the normal range. Intensive observation is recom-men ded to find the premonition of cerebral infarction, and preventive treatment should be taken to reduce the risk of cerebral infarction.

关 键 词：烟雾病 血管重建术 术后脑梗死 危险因素 

分 类 号：R743.1[医药卫生—神经病学与精神病学]