成人烟雾病及烟雾综合征患者脑血运重建术后高灌注综合征的临床特点及影响因素分析  

Study on clinical characteristics and influence factors of cerebral hyperperfusion syndrome after bypass surgery in adults patients with Moyamoya disease and Moyamoya syndrome

作　　者：朱乾渺 汤其凯 陈正新[1] 骆慧[1] 李瑞[1] 王慧博[1] 路华[1] 吴伟 Zhu Qianmiao;Tang Qikai;Chen Zhengxin;Luo Hui;Li Rui;Wang Huibo;Lu Hua;Wu Wei(Department of Neurosurgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院神经外科,210029

出　　处：《中国脑血管病杂志》2022年第11期749-755,共7页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的初步探究成人烟雾病及烟雾综合征患者脑血运重建术后脑高灌注综合征(CHS)的临床特点及影响因素。方法回顾性分析2018年9月至2021年3月于南京医科大学第一附属医院神经外科接受脑血运重建术治疗的成人烟雾病及烟雾综合征患者的临床资料。根据术后7 d内是否发生CHS,将所有患者分为CHS组和非CHS组。总结术后发生CHS患者的临床表现,比较两组患者的临床资料(年龄、性别、既往病史、临床分型、铃木分期、是否合并颅内动脉瘤、手术侧别等),采用改良Rankin量表(mRS)评分评估术后3个月门诊或电话随访的神经功能恢复情况,采用单因素分析和多因素Logistic回归分析方法(逐步回归法)分析血运重建术后CHS发生的影响因素。结果共纳入行脑血运重建术的烟雾病及烟雾综合征患者93例,其中男46例,女47例,平均年龄(43±11)岁。所有患者术中经吲哚氰绿造影明确桥血管通畅。术后7 d共有26例(28.0%)患者发生CHS,其中14例(53.8%)出现言语障碍伴反应迟钝,21例(80.8%)出现对侧肢体震颤、乏力、局灶性痫性发作,11例(42.3%)出现对侧肢体感觉障碍,22例(84.6%)出现持续剧烈的头晕伴头痛且影像学提示未见颅内出血及梗死灶,13例(50.0%)出现恶心、呕吐、反酸及食欲不佳;术后3个月mRS评分0~2分21例,3~5分5例。单因素分析结果显示,CHS组与非CHS组患者的年龄、临床分型、铃木分期、高血压病史、手术侧别及合并颅内动脉瘤差异有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,烟雾病及烟雾综合征患者中年龄(OR=1.121,95%CI:1.026~1.226,P=0.012)、高血压病史(OR=9.535,95%CI:2.283~39.825,P=0.002)为术后CHS的独立影响因素,年龄越高、具有高血压病史者,术后CHS发生风险越高。结论烟雾病及烟雾综合征患者脑血运重建术后CHS症状存在个体差异。较高的年龄、具有高血压病史为患者术后发生CHS的临床危Objective To explore the clinical characteristics and influence factors of cerebral hyperperfusion syndrome(CHS)after bypass surgery in adult patients with Moyamoya disease and Moyamoya syndrome.Methods The clinical data of adult patients with Moyamoya disease and Moyamoya syndrome,undergoing cerebral revascularization at the Department of Neurosurgery,the First Affiliated Hospital of Nanjing Medical University from September 2018 to March 2021 were analyzed retrospectively.According to whether CHS occurred within 7 days after surgery,all patients were divided into CHS group and non-CHS group.The clinical manifestations of the patients with postoperative CHS were summarized,and the clinical data(age,gender,past medical history,clinical classification,Suzuki staging,intracranial aneurysm,surgical side,etc.)of the two groups were compared.The neurological function recovery was evaluated by the modified Rankin Scale(mRS)score at the outpatient or by phone 3 months after the surgery.Univariate analysis and multivariate Logistic regression analysis(stepwise regression)were used to analyze the influence factors of CHS after cerebral revascularization surgery.Results A total of 93 patients with Moyamoya disease and Moyamoya syndrome receiving cerebral revascularization surgery were included,including 46 males and 47 females,with an average age of(43±11)years old.The bridged vessel patency was confirmed by intraoperative indocyanine green(ICG)fluorescence videoangiography.26 cases(28.0%)were with postoperative CHS 7 days after bypass surgery.Of those cases,14 cases(53.8%)showed aphasia and reaction dullness;21 cases(80.8%)had contralateral limb weakness,focal seizures,fatigue with decreased muscle power;11 cases(42.3%)developed contralateral limb sensory disturbances;22 cases(84.6%)had severe dizziness with headache and no intracranial hemorrhage or infarction on imaging;13 cases(50.0%)experienced nausea and vomiting with poor appetite.Three months after operation,21 cases had mRS scores of 0-2,and 5 cases had mRS score

关 键 词：脑底异常血管网病 脑血管重建术 危险因素 高灌注综合征 临床特征 

分 类 号：R743[医药卫生—神经病学与精神病学]