阿司匹林对接受脑-硬膜-动脉融通术治疗的成年缺血型烟雾病患者转归的影响

Effect of aspirin on the outcomes in adult patients with ischemic moyamoya disease treated with encephaloduroarteriosynangiosis

目的:探讨阿司匹林对接受脑-硬膜-动脉融通术(encephaloduroarteriosynangiosis,EDAS)治疗的成年缺血型烟雾病患者转归的影响。方法:回顾性纳入2015年1月至2018年9月在解放军总医院第五医学中心神经外科接受EDAS治疗的成年缺血型烟雾病患者。对照组仅实施EDAS治疗,阿司匹林组在EDAS的同时接受阿司匹林抗血小板治疗。对两组患者资料进行回顾性分析,比较手术有效率、围手术期脑出血发生率、术后6个月复发性脑血管事件发生率以及术后改良Rankin量表(modified Rankin Scale,mRS)评分改善率。结果:共纳入120例成年缺血型烟雾病患者,阿司匹林组和对照组各60例,对两组患者各107侧大脑半球进行了EDAS术。阿司匹林组手术有效率显著高于对照组(82.24%对65.42%;χ^(2)=7.836,P=0.005)。阿司匹林组和对照组围手术期均未发生脑出血事件,术后6个月内脑梗死发生率差异无统计学意义,但阿司匹林组短暂性脑缺血发作发生率显著低于对照组(15%对40%;χ^(2)=9.404,P=0.002)。此外,阿司匹林组术后6个月时mRS评分改善率显著高于对照组(85%对63.33%;χ^(2)=7.350,P=0.007)。结论:成年缺血型烟雾病患者在实施EDAS的同时联合使用阿司匹林,能有效改善患者转归,且不会增高围手术期脑出血风险。

Objective:To investigate the effect of aspirin on the outcomes in adult patients with ischemic moyamoya disease treated with encephaloduroarteriosynangiosis(EDAS).Methods:Adult patients with ischemic moyamoya disease treated EDAS in the Department of Neurosurgery,the Fifth Medical Center,PLA General Hospital from January 2015 to September 2018 were enrolled retrospectively.The control group only received EDAS treatment,and the aspirin group received EDAS and aspirin antiplatelet treatment.The data of the both groups were analyzed retrospectively and the effective rate of operation,the incidence of perioperative intracerebral hemorrhage,the incidence of recurrent cerebrovascular events at 6 months after operation and the improvement rate of the modified Rankin Scale(mRS)score were compared.Results:A total of 120 adult patients with ischemic moyamoya disease were enrolled,including 60 in the aspirin group and 60 in the control group.EDAS was performed on 107 cerebral hemispheres in both groups.The operative effective rate in the aspirin group was significantly higher than that in the control group(82.24%vs.65.42%;χ^(2)=7.836,P=0.005).There was no perioperative cerebral hemorrhage event in the aspirin group and the control group.There was no significant difference in the incidence of cerebral infarction within 6 months after operation,but the incidence of transient ischemic attack in the aspirin group was significantly lower than that in the control group(15%vs.40%;χ^(2)=9.404,P=0.002).In addition,the improvement rate of mRS score in the aspirin group at 6 months after operation was significantly higher than that in the control group(85%vs.63.33%;χ^(2)=7.350,P=0.007).Conclusions:The combination of EDAS and aspirin can effectively improve the outcomes of adult patients with ischemic moyamoya disease without increasing the risk of perioperative intracerebral hemorrhage.