联合脑血管重建术治疗成人烟雾病术后相关并发症的影响因素分析  

Influencing factors of postoperative complications of combined cerebral revascularization for the treatment of moyamoya disease in adults

作　　者：梁浩[1] 赵黎明 高涛 刘阳 孙玉学 郭高超 张韶 薛冰倩 李天晓 栗超跃 Liang Hao;Zhao Liming;Gao Tao;Liu Yang;Sun Yuxue;Guo Gaochao;Zhang Shao;Xue Bingqian;Li Tianxiao;Li Chaoyue(Department of Neurosurgery,Henan University People′s Hospital,Zhengzhou 450003,China;Department of Neurosurgery,Henan Provincial People′s Hospital(Zhengzhou University People′s Hospital),Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院神经外科,郑州450003 [2]河南省人民医院(郑州大学人民医院)神经外科,郑州450003

出　　处：《中华神经外科杂志》2021年第3期245-249,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨联合脑血管重建术治疗成人烟雾病术后相关并发症的影响因素。方法回顾性分析河南省人民医院神经外科2017年1月至2019年6月采用颞浅动脉-大脑中动脉搭桥术联合脑-硬膜-肌肉-血管融合术治疗的成人烟雾病患者的临床资料,共370例。观察单侧术后神经系统并发症的发生情况,应用单因素和多因素logistic回归分析法分析影响患者术后并发症的危险因素。术后采用改良Rankin量表评分(mRS)评估患者的临床疗效,根据基于数字减影血管造影(DSA)的Matsushima分级标准评估术侧的脑血流重建情况。结果370例患者手术均成功,术后75例(20.3%)发生神经系统相关并发症,其中脑出血6例、脑梗死12例、蛛网膜下腔出血2例、可逆性缺血性神经功能障碍29例、癫痫26例。15例患者预后差(mRS 3~6分),其中2例死亡。多因素logistic回归分析显示,术前首发症状为短暂性脑缺血发作(TIA)(OR=2.616,95%CI:1.442~4.744,P=0.002)、合并高血压病史(OR=2.308,95%CI:1.326~4.015,P=0.003)、术前mRS 3~5分(OR=2.371,95%CI:1.236~4.547,P=0.009)是患者术后发生并发症的危险因素。370例患者的随访时间为(15.6±5.3)个月(6~32个月)。末次随访mRS的中位数为1分(P_(25)、P_(75)分别为1、2分),与术前的2分(P25、P75分别为1、2分)比较,差异有统计学意义(P<0.01);362例患者行DSA检查,术侧Matsushima分级0级12例,1级121例,2级198例,3级31例。结论术前首发症状为TIA、合并高血压病史、术前mRS 3~5分的成人烟雾病患者,应用联合脑血管重建术治疗术后相关并发症的风险较高。Objective To explore the influencing factors of postoperative complications and efficacy of combined cerebral revascularization for the treatment of moyamoya disease(MMD)in adults.Methods A retrospective analysis was conducted about the clinical data of 370 adult patients with moyamoya disease who underwent combined cerebral revascularization(superficial temporal artery-middle cerebral artery anastomosis+encepho-duro-myo-synangiosis)at Department of Neurosurgery,Henan Provincial People′s Hospital from January 2017 to June 2019.The incidence of neurological complications after unilateral operation was observed,and the risk factors of postoperative complications were analyzed by univariate and multivariate logistic regression analyses.The clinical efficacy of the patients was evaluated based on the modified Rankin Scale(mRS),and the cerebral blood flow reconstruction was evaluated according to the Matsushima score standard based on digital subtraction angiography(DSA)results.Results All 370 patients underwent successful operation,and 75 cases(20.3%)developed neurological complications after operation,including 6 cases of cerebral hemorrhage,12 cases of cerebral infarction,2 cases of subarachnoid hemorrhage,29 cases of transient neurological defect and 26 cases of epilepsy.The outcomes of 15 patients were poor(mRS 3-6 points),of which 2 patients died.Multivariate logistic regression analysis showed that the development of TIA as the first symptom before operation(OR=2.616,95%CI:1.442-4.744,P=0.002),comorbidity with essential hypertension(OR=2.308,95%CI:1.326-4.015,P=0.003),and preoperative mRS of 3-5 points(OR=2.371,95%CI:1.236-4.547,P=0.009)were risk factors for postoperative complications.The follow-up time of 370 patients was 15.6±5.3 months(6-32 months).The median mRS at the last follow-up was 1 point(P_(25):1 point;P_(75):2 points),which was significantly different from preoperative mRS(median:2 points;P_(25):1 point;P_(75):2 points)(P<0.01).A total of 362 patients underwent DSA examination.Among them,grade

关 键 词：脑底异常血管网病 成年人 脑血管重建术 手术后并发症 因素分析 统计学 

分 类 号：R651.12[医药卫生—外科学]