烟雾病联合血运重建术术后严重并发症的风险因素分析

Analysis of risk factors for severe complications after combined bypass in patients with Moyamoya disease

目的:分析影响烟雾病联合血运重建术术后严重并发症的风险因素。方法:回顾性纳入2015年6月至2018年10月在武汉大学中南医院神经外科收治的153例患者,共进行了170次脑血运重建手术,所有患者都采用颞浅动脉-大脑中动脉(STA-MCA)搭桥术联合颞肌贴敷术(EMS)术。运用单因素分析和多因素Logistic回归分析影响烟雾病患者联合血运重建术后严重并发症的风险因素。结果:术后发生严重并发症23例(13.5%),其中高灌注综合征10例,脑出血10例,脑梗死3例。单因素分析结果示糖尿病、高血压、饮酒和手术时机(<3个月)是影响烟雾病患者术后严重并发症的危险因素。对以上因素进一步行多因素Logistic回归分析发现,高血压(OR=4.889,95%CI:1.629~14.673,P=0.005)和手术时机(<3个月)(OR=9.71,95%CI:3.392~27.799,P<0.001)是影响烟雾病患者术后严重并发症的独立危险因素。结论:高血压病史和手术时机(<3个月)是烟雾病患者术后发生严重并发症的独立危险因素。

Objective:To analyze the risk factors related to severe complications after undergoing the com-bined bypass in patients with Moyamoya disease.Methods:We conducted a retrospective study on 153 patients with Moyamoya disease admitted to the Neurosurgery Department of Zhongnan Hospital of Wuhan University from June 2015 to October 2018.A total of 170 cerebrovascular reconstruction operations were performed.All patients were treated with combined bypass.Univariate and multivariate logistic regression analysis were used to analyze the risk factors of severe postoperative complications in patients with Moyamoya disease.Results:There were 23 cases(13.5%)of severe complications after operations,including 10 cases of cerebral hyperperfusion syndrome,10 cases of cerebral hemorrhage,and 3 cases of cerebral infarction.Univariate analysis showed that diabetes,hypertension,drinking and timing of surgery(<3 months)were risk factors for severe postoperative complications in patients with Moyamoya disease.Furthermore,multivariate logistic regression analysis of the above factors found that hypertension(OR=4.889,95%CI:1.629-14.673,P=0.005)and timing of surgery(<3 months)(OR=9.71,95%CI:3.392-27.799,P<0.001)were independent risk factors of severe postoperative complications in patients with Moyamoya disease.Conclusion:Hypertension and the timing of surgery(<3 months)are independent risk factors for severe complications in patients with Moyamoya disease.