175例烟雾病血管重建术后12例发生脑梗死的危险因素分析

doi:10.6040/j.issn.1671-7554.0.2019.850

摘要/Abstract

摘要： 目的探讨烟雾病患者血管重建术后发生脑梗死的危险因素及相应的预防措施。方法回顾性分析175例接受血管重建手术的烟雾病患者临床病例资料,根据术后是否新发脑梗死将其分为阳性组和阴性组,将两组患者人口统计学特征、合并症,术前、术中、术后血压等因素进行单因素、多因素分析,分析烟雾病血管重建术后发生脑梗死的危险因素。结果血管重建术后脑梗死发生率为6.8%(12/175),单因素分析结果显示,阳性组和阴性组患者在年龄、糖尿病及高血压病史、术前收缩压均值、术前舒张压均值及术前近1个月伴有短暂性脑缺血发作差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,合并糖尿病、高血压、术前收缩压高为术后新发脑梗死的独立危险因素(P<0.05)。结论糖尿病、高血压、术前收缩压增高是术后脑梗死的危险因素,建议对上述患者尽早辅以药物进行干预,严格控制血糖、血压水平,术前收缩压控制在正常范围内,术后密切观察病情变化,及时发现脑梗死前兆,给予早期干预,以减少脑梗死的发生。

关键词: 烟雾病, 血管重建术, 术后脑梗死, 危险因素

Abstract: Objective To evaluate the risk factors for cerebral infarction after vascular reconstruction for Moyamoya disease(MMD), and to explore the preventive strategies. Methods The clinical data of 175 MMD patients were retrospectively analyzed and the patients were classified into positive group and negative group according to the occurrence of emerging infarction. Demographic data, comorbidities, and preoperative, intraoperative and postoperative blood pressure were compared. Univariate and multivariate regression analyses were performed to explore the risk factors for cerebral infarction. Results The incidence of cerebral infarction was 6.8%(12/175). Univariate analysis revealed that age, diabetes, hypertension, preoperative mean systolic blood pressure, preoperative mean diastolic blood pressure, and transit ischemic attack were significantly different between the positive and negative groups (P<0.05). Multivariate analysis demonstrated that comorbidity with diabetes and hypertension, and high systolic pressure are independent risk factors for new cerebral infarction after vascular reconstruction for MMD (P<0.05). Conclusion Comorbidity with diabetes and hypertension, and high systolic pressure are independent risk factors for cerebral infarction after vascular reconstruction. Medical intervention is recommended for patients with these risk factors to control the blood sugar and blood pressure and to maintain the preoperative systolic pressure within the normal range. Intensive observation is recom- 山东大学学报 (医学版)57卷10期 -赵亚妮,等.175例烟雾病血管重建术后12例发生脑梗死的危险因素分析 \=-men ded to find the premonition of cerebral infarction, and preventive treatment should be taken to reduce the risk of cerebral infarction.

Key words: Moyamoya disease, Revascularization, Cerebral infarction, Risk factor

中图分类号:

R743.1

赵亚妮,栾晓嵘,李海燕. 175例烟雾病血管重建术后12例发生脑梗死的危险因素分析[J]. 山东大学学报 (医学版), 2019, 57(10): 93-100.

ZHAO Yani, LUAN Xiaorong, LI Haiyan. Risk factor for cerebral infarction in 12 patients after revascularization of 175 patients with Moyamoya disease[J]. Journal of Shandong University (Health Sciences), 2019, 57(10): 93-100.

参考文献

[1] Abla AA, Gandhoke G, Clark JC, et al. Surgical outcomes for moyamoya angiopathy at barrow neurological institute with comparison of adult indirect encephaloduroarteriosynangiosis bypass, adult direct superficial temporal artery-to-middle cerebral artery bypass, and pediatric bypass: 154 revascularization surgeries in 140 affected hemispheres [J]. Neurosurgery, 2013, 73(3): 430-439.
[2] Fujimura M, Bang OY, Kim JS. Moyamoya Disease [J]. Front Neurol Neurosci, 2016, 40: 204-220.
[3] Bao XY, Duan L, Yang WZ, et al. Clinical features, surgical treatment, and long-term outcome in pediatric patients with moyamoya disease in China [J]. Cerebrovasc Dis, 2015, 39(2): 75-81.
[4] Kang S, Liu X, Zhang D, et al. Natural course of moyamoya disease in patients with prior hemorrhagic stroke [J]. Stroke, 2019, 50(5): 1060-1066.
[5] Bower RS, Mallory GW, Nwojo M, et al. Moyamoya disease in a primarily white, midwestern US population: increased prevalence of autoimmune disease [J]. Stroke, 2013, 44(7): 1997-1999.
[6] Li Q, Gao Y, Xin W, et al. Meta-analysis of prognosis of different treatments for symptomatic moyamoya disease [J]. World Neurosurg, 2019, 127: 354-361. doi: 10.1016/j.wneu.2019.04.062.
[7] Acker G, Fekonja L, Vajkoczy P. Surgical management of moyamoya disease [J]. Stroke, 2018, 49(2): 476-482.
[8] Kim T, Oh CW, Bang JS, et al. Moyamoya disease: treatment and outcomes [J]. J Stroke, 2016, 18(1): 21-30.
[9] 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J]. 中华神经科杂志, 2010, 43(2): 4013-4017. Chinese Medical Association Neurology Society Cerebral Vascular Society Cerebral Ischemic Stroke Diagnosis and Treatment Guidelines Writing Group. China Acute Ischemic Stroke Diagnosis and Treatment Guidelines 2010 [J]. Chinese Journal of Neurology, 2010, 43(2): 4013-4017.
[10] Kazumata K, Ito M, Tokairin K, et al. The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review [J]. J Neurosurg, 2014, 121(2): 432-440.
[11] Funaki T, Takahashi JC, Takagi Y, et al. Unstable moyamoya disease: clinical features and impact on perioperative ischemic complications [J]. J Neurosurg, 2015, 122(2): 400-407.
[12] Zhao M, Deng X, Zhang D, et al. Risk factors for and outcomes of postoperative complications in adult patients with moyamoya disease [J]. J Neurosurg, 2018, 1: 1-12. doi: 10.3171/2017.10.JNS171749.
[13] Zhao M, Deng X, Gao F, et al. Ischemic stroke in young adults with moyamoya disease: prognostic factors for stroke Recurrence and Functional Outcome after Revascularization [J]. World Neurosurg, 2017, 103: 161-167. doi: 10.1016/j.wneu.2017.03.146.
[14] Ge P, Zhang Q, Ye X, et al. Clinicalfeatures, surgical treatment, and long-term outcome in elderly patients with moyamoya disease [J]. World neurosurg, 2017, 100: 459-466. doi: 10.1016/j.wneu.2017.01.055.
[15] Park W, Ahn JS, Lee HS, et al. Risk factors for newly developed cerebral infarction after surgical revascularization for adults with moyamoya disease [J]. World Neurosurg, 2016, 92: 65-73. doi: 10.1016/j.wneu.2016.03.053.
[16] Wei W, Chen X, Yu J, et al. Risk factors for postoperative stroke in adult patients with moyamoya disease: a systematic review with meta-analysis [J]. BMC Neurology, 2019, 19(1): 98-105.
[17] 班峰. 围手术期卒中的风险评估、预防及治疗[D]. 石家庄:河北医科大学, 2017: 1-23.
[18] Kim S, Choi J, Yang K, et al. Risk factors for postoperative ischemic complications in patients with moyamoya disease [J]. J Neurosurg, 2005, 103(5 Suppl): 433-440.
[19] 鲁志科, 孙榕. 高血压病患者降压治疗前后颈、股动脉弹性改善程度的研究[J]. 湖南师范大学学报(医学版), 2019, 16(2): 105-108. LU Zhike, SUN Rong. Study on the improvement of the elasticity of the carotid and femoral artery before and after hypertension treatment [J]. Journal of Hunan Normal University(Health Sciences), 2019, 16(2): 105-108.
[20] Noh HJ,Kim SJ,Kim JS,et al. Long term outcome and predictors of ischemic stroke recurrence in adult moyamoya disease [J]. Journal of the Neurological Sciences, 2015, 359(1-2): 381-388.
[21] 张苗怡, 唐杰, 刘娜, 等. 血管重建术对不同类型烟雾病患者卒中复发及功能预后的影响[J]. 复旦学报(医学版), 2018, 45(4): 478-484. ZHANG Miaoyi, TANG Jie, LIU Na, et al. Effects of revascularization on recurrence and functional prognosis of patients with moyamoya disease [J]. Journal of Fudan University(Health Sciences), 2018, 45(4): 478-484.
[22] 任斌. 烟雾病伴发Ⅱ型糖尿病的临床表现及其脑血管重建的特征[D]. 北京:中国人民解放军军事医学科学院, 2016: 1-92.
[23] 朱爱群, 张静平, 邹婷, 等. 血压、血糖、血脂与不同年龄、性别脑卒中的相关性[J]. 中南大学学报(医学版), 2014, 39(12): 1271-1278. ZHU Aiqun, ZHANG Jingping, ZOU Ting, et al. Correlation of blood pressure, blood glucose and blood lipid with stroke of different age and sex[J]. Journal of Central South University(Health Sciences), 2014, 39(12): 1271-1278.
[24] Ren B, Zhang ZS, Liu WW, et al. Surgical outcomes following encephaloduroarteriosynangiosis in adult moyamoya disease associated with Type 2 diabetes [J]. J neurosurg, 2016, 125(2): 308-314.
[25] Li J, Zhao Y, Zhao M, et al. High variance of intraoperative blood pressure predicts early cerebral infarction after revascularization surgery in patients with Moyamoya disease[J]. Neurosurg Rev, 2019, 15. doi: 10.1007/s10143-019-01118-z.
[26] 吴彦. 高血压患者在围术期的血压控制要点[J]. 中国医学前沿杂志(电子版), 2014, 6(4): 9-12. WU Yan. Key points of blood pressure control in patients with hypertension during perioperative period [J]. Chinese Journal of the Frontiers of Medical Science(Electronic Version), 2014, 6(4): 9-12.
[27] 中国高血压防治指南修订委员会高血压联盟, 中华医学会心血管病学分会, 中国医师协会高血压专业委员会, 等. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1): 24-56. China Hypertension Prevention and Treatment Guidelines Revision Committee Hypertension League, Chinese Medical Association Cardiovascular Branch, Chinese Medical Association Hypertension Professional Committee, etc. China Guidelines for Prevention and Treatment of Hypertension(Revised Edition, 2018)[J]. Chinese Journal of Cardiology, 2019, 24(1): 24-56.
[28] Sato K, Shirane R, Yoshimoto T. Perioperative factors related to the development of ischemic complications in patients with moyamoya disease [J]. Childs Nerv Syst, 1997, 13(2): 68-72.
[29] Iwama T, Hashimoto N, Yonekawa Y. The relevance of hemodynamic factors to perioperative ischemic complications in childhood moyamoya disease [J]. Neurosurgery, 1996, 38(6): 1120-1125.

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