联合搭桥术治疗烟雾病血流动力学前瞻性研究  

Efficacy of combined bypass surgery in the treatment of moyamoya disease from the perspective of hemodynamics:a prospective study

作　　者：胡坤[1] 周小平 叶丽芳 张震宇[1] 蒋秋华[1] 黄锦庆[1] HU Kun;ZHOU Xiaoping;YE Lifang;ZHANG Zhenyu;JIANG Qiuhua;HUANG Jinqing(Department of Neurosurgery,Ganzhou People′s Hospital,Ganzhou,Jiangxi 341000,China)

机构地区：[1]江西省赣州市人民医院神经外科,江西赣州341000

出　　处：《检验医学与临床》2022年第3期301-304,共4页Laboratory Medicine and Clinic

基　　金：江西省卫生健康委员会科技计划(20183450)。

摘　　要：目的探讨在联合搭桥术中从血流动力学角度选择不同受体血管进行烟雾病(MMD)治疗的临床效果及预后情况。方法选取该院2018年8月至2020年1月接受联合搭桥手术治疗的MMD患者90例,采用随机数字表法将患者分为A、B、C组,每组30例,其中A组选择搭桥术中荧光造影术野显影最快的血管为受体血管,B组选择术野显影最慢的血管为受体血管,C组为常规选择受体血管。观察3组患者受体血管搭桥前后压力值、手术前后脑血流量(CBF)和改良Rankin量表(mRS)评分,并比较3组患者门诊随访6个月临床症状改善情况、再发卒中情况、CBF及mRS评分。结果3组患者搭桥后受体血管压力值较同组搭桥前明显升高,A、B组搭桥后受体血管压力值及压差高于C组,且B组高于A组(P<0.05);3组患者术后7 d和随访6个月CBF较同组术前明显升高,A、B组CBF均高于C组,且术后7 d B组CBF高于A组(P<0.05);3组患者术后7 d和随访6个月mRS评分较同组术前明显降低,随访6个月mRS评分较同组术后7 d降低,A、B组mRS评分低于C组(P<0.05);B组患者临床症状发生率均优于A、C组(P<0.05)。结论从血流动力学角度选择术野显影最慢的血管为受体血管进行MMD颅内外血管搭桥治疗临床效果及预后情况更好。Objective To investigate the clinical efficacy and prognosis of patients with moyamoya disease(MMD)treated by hemodynamic selection of recipient vessels in combined bypass surgery.Methods A total of 90 patients with MMD underwent combined bypass surgery in the hospital from August 2018 to January 2020 were selected and divided into three groups A,B and C by the random number table method,with 30 cases in each group.In group A,the recipient vessel with the fastest visualization in the surgical field was selected;in group B,the recipient vessel with the slowest visualization in the surgical field was selected;in group C,the routine recipient vessel was selected.Vascular pressure before and after bypass,cerebral blood flow(CBF)before and after surgery,modified Rankin scale(mRS)score were observed and compared,as well as clinical symptoms improvement,stroke recurrence,CBF and mRS scores after 6 months of outpatient follow-up.Results The pressure of the recipient vessel after the bypass in the three groups of patients was significantly higher than that in the same group before the bypass.The pressure value and the pressure difference of the recipient vessel after the bypass in groups A and B were higher than those in the group C(P<0.05).The CBF of the three groups was significantly higher than that of the same group at 7 d postoperatively and 6 months of follow-up.The CBF of group A and group B were higher than that of group C,and the CBF of group A was higher than that of group B at 7 d postoperatively(P<0.05).The mRS scores at 7 d postoperatively and 6 months of follow-up were significantly lower than those of the same group before the operation.The mRS scores in the 6 months of follow-up were lower than those in the same group 7 d after the operation,and the mRS scores of groups A and B were lower than those of group C(P<0.05).The clinical symptoms of patients in group B were significantly improved compared with group A and group C(P<0.05).Conclusion From the perspective of hemodynamics,choosing the vessels with th

关 键 词：烟雾病 联合搭桥术 受体血管选择性 血流动力学 

分 类 号：R445.1[医药卫生—影像医学与核医学] R743[医药卫生—诊断学]