缺血型烟雾病搭桥术后脑过度灌注综合征的预测因素分析  

Predicative factors for cerebral hyperperfusion syndrome after bypass operation of ischemic moyamoya disease

作　　者：张白[1] 惠品晶[1] 蔡忻懿 颜燕红[1] 张翌 杨柳[1] 黄亚波[1] 韩庆东[1] 周鹏[1] Zhang Bai;Hui Pinjing;Cai Xinyi;Yan Yanhong;Zhang Yi;Yang Liu;Huang Yabo;Han Qingdong;Zhou Peng(Department of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院神经外科,苏州215006

出　　处：《中华神经外科杂志》2024年第11期1098-1103,共6页Chinese Journal of Neurosurgery

基　　金：苏州市民生科技项目(SS202061);苏州大学技术合作项目(H211064)。

摘　　要：目的探讨缺血型烟雾病(MMD)患者行颞浅动脉(STA)-大脑中动脉(MCA)搭桥术中血流动力学参数及围手术期血压对术后脑过度灌注综合征(CHS)的预测作用。方法回顾性分析2018年1月至2022年12月苏州大学附属第一医院神经外科行单侧STA-MCA搭桥术的123例缺血型MMD患者的临床资料。术中应用微型探头血管超声检测并记录吻合后受血动脉MCA皮质支(M4段)及供血动脉STA顶支的血流动力学参数, 包括收缩期峰值流速(Vp)、平均流速(Vm)、舒张期末流速(Vd)、脉动指数(PI)。记录围手术期血压变化。根据术后是否出现CHS, 分为CHS组(32例)及非CHS组(91例)。将可能影响术后发生CHS的因素纳入多因素logistic回归模型, 分析影响术后CHS的危险因素。通过受试者工作特征(ROC)曲线及曲线下面积(AUC)分析各参数预测术后发生CHS的诊断价值。结果两组间年龄、性别、高血压、高脂血症、血脂水平等基线资料的差异均无统计学意义(均P>0.05)。CHS组MCA M4近心段的Vp、Vm、Vd, STA的Vm、Vd以及术中、术后血压均高于非CHS组(均P<0.05)。多因素logistic回归模型分析结果显示, 术中较高的MCA M4近心段的Vm(OR=1.06, 95%CI:1.01~1.12, P=0.014)、术中收缩压(OR=1.08, 95%CI:1.00~1.16, P=0.040)及术后收缩压(OR=1.09, 95%CI:1.01~1.17, P=0.023)均为MMD患者术后发生CHS的危险因素。ROC曲线分析结果显示, 术中MCA M4近心段的Vm、术中收缩压、术后收缩压预测MMD患者术后发生CHS的AUC(95%CI)分别为0.83(0.74~0.93)、0.84(0.75~0.94)、0.75(0.64~0.86)(均P<0.01), 最佳截断值分别为52 cm/s、131 mm Hg (1 mm Hg=0.133 kPa)、148 mm Hg;其灵敏度分别为0.742、0.742、0.839, 特异度分别为0.867、0.822、0.644。与单一因素模型相比, 三者联合模型(AUC=0.90, 95%CI:0.84~0.97, P<0.01)预测MMD患者术后发生CHS的准确性更高, 其灵敏度为0.839, 特异度为0.844。结论对于缺血型MMD患者, 搭桥术中较高的MCA M4近心段VObjective To investigate the predictive role of hemodynamic parameters monitored during superficial temporal artery(STA)-middle cerebral artery(MCA)bypass surgery and perioperative blood pressure on cerebral hyperperfusion syndrome(CHS)in patients with ischemic moyamoya disease(MMD).Methods A retrospective analysis was conducted on 123 patients with ischemic MMD who underwent unilateral STA-MCA bypass surgery at the Department of Neurosurgery,the First Affiliated Hospital of Soochow University from January 2018 to December 2022.Intraoperatively,microprobevascular doppler(MVD)was used to monitor and record the hemodynamic parameters of the recipient artery MCA cortical branch(M4)and the donor artery,i.e.,superficical temporal artery(STA),including peak systolic velocity(Vp),mean velocity(Vm),end-diastolic velocity(Vd),and pulsatility index(PI).Perioperative blood pressure changes were also recorded.Patients were divided into CHS group(32 cases)and non-CHS group(91 cases)based on the presence or absence of CHS clinical manifestations postoperatively.A multivariate logistic regression model was established to analyze the risk factors for postoperative CHS.The diagnostic value of predicting postoperative CHS was analyzed through receiver operating characteristic(ROC)curve and AUC(area under the curve).Results There were no statistically significant differences in age,sex,hypertension,hyperlipidemia,or blood lipid levels between the two groups(all P>O.05).The CHS group had higher Vp,Vm,and Vd in the proximal segment of M4,higher Vm and Vd in STA,and higher intraoperative and postoperative blood pressure compared with the non-CHS group(all P<0.05).Multivariate logistic regression analysis results showed that higher Vm in the proximal segment of M4(OR=1.06,95%Cl:1.01-1.12,P=0.014),intraoperative(0R=1.08,95%CI:1.00-1.16,P=0.040)and postoperative systolic blood pressure(OR=1.09,95%CI:1.01-1.17,P=0.023)were risk factors for postoperative CHS.ROC curve analysis showed that Vm of 52 cm/s in the proximal segment of M4(AUC=0.8

关 键 词：脑底异常血管网病 超声检查 多普勒 血流动力学 脑血运重建术 脑过度灌注综合征 

分 类 号：R651.1[医药卫生—外科学]