面肌痉挛术后迟发性面瘫发生的Logistic 回归分析  被引量:3

Logistics regression analysis of occurrence of delayed facial paralysis after hemifacial spasm surgery

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作  者:陈永军 张恒[1] 孙华东 曾辉[1] CHEN Yongjun;ZHANG Heng;SUN Huadong;ZENG Hui(West China Hospital,Sichuan University,Chengdu 610041,China;Hospital,Chengdu 610000,China)

机构地区:[1]四川大学华西医院,四川成都610041 [2]三六三医院,四川成都610000

出  处:《中国实用神经疾病杂志》2022年第4期459-464,共6页Chinese Journal of Practical Nervous Diseases

基  金:四川省医学科研青年创新课题(编号:Q19021)。

摘  要:目的探讨影响面肌痉挛术后迟发性面瘫(DFP)发生的相关危险因素,并提出针对性的预防措施。方法回顾性纳入2018-06—2020-06于四川大学华西医院行显微血管减压术(MVD)的面肌痉挛(HFS)患者307例。术后门诊或电话随访,评估DFP发生及恢复情况。将术后发生DFP患者作为观察组,将术后未发生DFP患者作为对照组。统计2组患者一般资料,对正态分布的连续变量采用t检验;非正态分布的连续变量采用非参数秩和检验;计数数据采用χ^(2)检验;以多因素Logistic回归分析影响患者术后发生DFP的危险因素;采用Pearson检验分析DFP发生时间与症状持续时间的相关性。结果307例患者随访3~12(8.34±2.15)月;术后1周内并发症发生率为13.36%(41/307);术后DFP发生率为10.10%(31/307),均于术后2个月内发生,并于发生后1 a内完全恢复正常。31例DFP患者发生时间为术后18(5,46)d,恢复正常时间117(17,222)d。2组患者性别、年龄、合并基础疾病、患侧、吸烟、饮酒、术前保守治疗情况、Cohen分级、责任血管类型比较差异无统计学意义(P>0.05);观察组术前病程>5 a,责任血管数≥2条,面神经有压痕、围术期使用尼莫地平占比分别为67.74%(21/31)、58.06%(18/31)、64.52%(20/31)、70.97%(22/31),明显高于对照组的42.03%(116/276)、25.00%(69/276)、34.42%(95/276)、46.01%(127/276),差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,术前病程>5 a、责任血管数≥2、面神经有压痕是术后发生DFP的危险因素(P<0.05);围术期尼莫地平使用是术后发生DFP的保护因素(P<0.05)。Pearson相关性分析结果显示,DFP发生时间与症状持续时间呈正相关(r=0.896,P<0.001)。结论术前病程越长、责任血管数越多以及面神经有压痕,则术后出现DFP可能性越高,而围术期使用尼莫地平则可减少DFP的发生。早治疗、术中轻柔操作、保护面神经、术后及时对症支持治疗可减少MVD患者DFP的发生�Objective To explore the related risk factors affecting the occurrence of delayed facial paralysis(DFP)after hemifacial spasm surgery,and to propose the targeted preventive measures.Methods The clinical data of 307 patients with hemifacial spasm(HFS)who underwent microvascular decompression(MVD)in the hospital were retrospectively analyzed between June 2018 and June 2020.Postoperative outpatient service or telephone follow-up was performed to evaluate the occurrence of DFP and recovery status.The patients with postoperative DFP were enrolled as observation group,while the patients without postoperative DFP were included in control group.The general data of the two groups of patients were statistically analyzed,and t test was used for continuous variables with normal distribution and non-parametric rank-sum test was adopted for continuous variables with non-normal distribution.χ2 test was used for enumeration data.Multivariate Logistic regression analysis was used to analyze the risk factors of occurrence of postoperative DFP,and Pearson test was adopted to analyze the correlation between occurrence time of DFP and symptom duration.Results Totally 307 patients were followed up for 3 to 12 months,with an average of(8.34±2.15)months.The incidence rate of complications within 1 week after surgery was 13.36%(41/307).The incidence rate of postoperative DFP was 10.10%(31/307),all of which occurred within 2 months after surgery and returned to normal within 1 year after the occurrence.The occurrence time of 31 patients with DFP was 18(5,46)d after surgery,and the time of returning to normal was 117(17,222)d.There were no statistical differences in gender,age,underlying diseases,affected side,smoking,drinking,preoperative conservative treatment status,Cohen classification and type of offending vessels between the two groups(P>0.05).The proportions of preoperative course of disease>5 years,the number of offending vessels≥2,facial nerve indentation and perioperative nimodipine use were 67.74%(21/31),58.06%(18/31),64.52%

关 键 词:面肌痉挛 显微血管减压术 迟发性面瘫 危险因素 

分 类 号:R745.12[医药卫生—神经病学与精神病学]

 

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