儿童烟雾病脑血管重建术后脑血流状况与预后的关系

Association between Hemodynamics and Efficacy of Revascularization in Childhood Moyamoya Disease

目的:探讨儿童烟雾病脑血管重建术后脑血流状况与临床预后的相关性。方法:32例实施脑-硬脑膜-动脉血管贴敷术(EDAS)的儿童烟雾病患者在手术前及术后6至12个月分别行经颅多普勒超声(TCD)检测。对患者手术前、后颞浅动脉流速、大脑中动脉(MCA)主干及远端峰值流速(Vp)、舒张期流速(Vd)、平均流速(Vm)及搏动指数(P I)结果进行对比,分析手术前、后脑血流状况变化特点及其与临床预后的关系。结果:在32例患者中,术后脑血流明显改善者26例,其中临床预后佳者16例,良7例,一般3例;脑血流无改善者6例,其中临床预后佳者0例,良2例,一般3例,差1例。脑血流状况与临床预后间有显著相关性(P<0.05)。结论:TCD可以检测儿童烟雾病患者EDAS手术前后的脑血流变化,EDAS术后患者脑血流状况与其临床预后具有相关性。

Objective：To investigate the association between hemodynamics and efficacy of revascularization in childhood moyamoya disease.Methods：32 children with moyamoya disease were enrolled in this study.All patients underwent transcranial cerebral Doppler（TCD） before encephalo-duro-arterio-synangiosis（EDAS） and at 6-12 months after EDAS.The data of Peak velocity（Vp）,diastolic velocity（Vd）,mean velocity（Vm） and pulsatility index（PI） of MCA before and after EDAS have been analyzed.Results： Among the 26 cases whose hemodynamics has been significantly improved after surgery,the clinical prognosis were excellent in 16 cases,good in 7 cases,fair in 3 cases,and poor in 0 case.Among the 6 cases whose hemodynamics has not been improved after surgery,the clinical outcomes were excellent in 0 case,good in 2 cases,fair 3 cases,and poor in 1 case.The association between the hemodynamics after EDAS and the efficacy of revascularization was significant（P〈0.05）.Conclusions： TCD can detect changes of cerebral blood flow in patients with childhood moyamoya disease and help to predict the efficacy of EDAS.