成人烟雾病患者颅内外血运重建术后早期神经系统并发症的危险因素

Risk factors for early neurological complications after revascularization in adult patients with moyamoya disease

目的筛选成人烟雾病患者颅内外血运重建术后早期神经系统并发症的危险因素。方法回顾性收集2017年1月至2019年6月于本院行颅内外血运重建术烟雾病患者的病例资料,性别不限,年龄18~65岁,ASA分级Ⅱ或Ⅲ级。根据患者是否发生术后早期神经系统并发症,分为术后早期神经系统并发症组和未发生术后早期神经系统并发症组。收集患者年龄、性别、术前临床症状、既往高血压病史、糖尿病病史、冠心病病史、ASA分级、麻醉方式、手术方式、麻醉时间、手术开始时间、手术时间、术中尿量、术中血管活性药使用次数和麻醉后观察室(PACU)停留时间等因素。采用logistic回归分析筛选发生术后早期神经系统并发症的危险因素。结果最终共纳入行颅内外血运重建术的成人烟雾病患者510例,术后早期神经系统并发症发生率为9.0%。logistic回归分析结果显示,术前缺血、术中血管活性药物使用>3次和PACU停留时间>90 min是术后神经系统并发症发生的危险因素(P<0.05)。结论术前缺血、术中血管活性药物使用>3次和PACU停留时间>90 min是成人烟雾病患者颅内外血运重建术后早期神经系统并发症的危险因素。

Objective To identify the risk factors for early neurological complications after revascularization in adult patients with moyamoya disease.Methods The medical records of patients of both sexes with moyamoya disease,aged 18-65 yr,of American Society of Anesthesiologists physical statusⅡorⅢ,who underwent revascularization in our hospital from January 2017 to June 2019,were retrospectively collected.According to the occurrence of early postoperative neurological complications,patients were divided into early postoperative neurological complication group and non-early postoperative neurological complication group.The factors such as patient′s age,gender,preoperative clinical symptoms,previous history of hypertension,history of diabetes,history of coronary heart disease,American Society of Anesthesiologists physical status,methods of anesthesia,type of operation,anesthesia time,time for start of operation,operation time,intraoperative urine volume,times of intraoperative vasoactive drugs used,and time of the post-anaesthesia observation room(PACU)stay were collected.Logistic regression analysis was used to identify the risk factors for postoperative early neurological complications.Results A total of 510 adult patients with moyamoya disease underwent revascularization were enrolled in this study,and the incidence of early postoperative neurological complications was 9.0%.The results of logistic regression analysis showed that preoperative ischemia,intraoperative use of vasoactive drugs more than 3 times and PACU stay time>90 min were risk factors for postoperative neurological complications(P<0.05).Conclusion Preoperative ischemia,intraoperative use of vasoactive drugs>3 times and PACU stay time>90 min are risk factors for early neurological complications after revascularization in the patients with moyamoya disease.