烟雾病脑血管重建术后脑过度灌注综合征临床特点及预测因素分析

Clinical features and predictive factors of cerebral hyperperfusion syndrome after cerebrovascular reconstruction in moyamoya disease

目的总结烟雾病脑血管重建术后脑过度灌注综合征的临床特点,并筛查相关预测因素。方法收集2017年6月至2018年12月在南昌大学第二附属医院行脑血管重建术的烟雾病患者的性别、年龄、高血压病史、发病类型、术前Suzuki分期、手术侧别、手术前后平均动脉压,以及手术至脑过度灌注综合征出现时间、临床表现、症状持续时间和术后住院时间等临床资料。单因素和多因素Logistic回归分析筛查烟雾病脑血管重建术后发生脑过度灌注综合征的相关预测因素,Spearman秩相关分析探讨手术至症状出现时间与症状持续时间的相关性。结果共纳入50例患者,13例术后发生脑过度灌注综合征,发生率为26%。Logistic回归分析显示,年龄偏高(OR=0.867,95%CI:0.790~0.953;P=0.003)和左侧手术(OR=0.158,95%CI:0.029~0.863;P=0.033)是烟雾病患者术后发生脑过度灌注综合征的预测因素。Spearman秩相关分析显示,脑过度灌注综合征患者手术至症状出现时间与症状持续时间呈负相关关系(r_(s)=-0.925,P=0.000)。结论脑过度灌注综合征是烟雾病患者脑血管重建术后的自限性并发症,年龄偏高和左侧手术可以作为预测其发生的影响因素。

Objective To summarize the clinical features of cerebral hyperperfusion syndrome(CHS)after cerebrovascular reconstruction for moyamoya disease(MMD),and to screen its related predictive factors.Methods The clinical data of 50 patients with MMD who underwent cerebrovascular reconstruction in the Second Affiliated Hospital of Nanchang University from June 2017 to December 2018 were collected,including sex,age,history of hypertension,disease type,preoperative Suzuki stage,surgery side,mean arterial pressure(MAP)before and after surgery,time from surgery to onset of CHS,clinical manifestations,duration of symptoms,and postoperative hospital stay.Univariate and multivariate Logistic regression analysis were used to screen the related predictors of CHS after cerebrovascular reconstruction for MMD.Spearman rank correlation analysis to explore the correlation between time from surgery to symptom onset and duration of symptoms.Results Among the 50 patients,13 patients(26%)developed CHS after surgery.Logistic regression analysis showed that over age(OR=0.867,95%Cl:0.790-0.953;P=0.003)and left-side surgery(OR=0.158,95%CI:0.029-0.863;P=0.033)was predictor of postoperative CHS in patients with MMD.Spearman rank correlation analysis showed that the time from surgery to symptom onset was negatively correlated with duration of symptom in patients with CHS(r_(s)=-0.925,P=0.000).Conclusions CHS is a self-limiting complication after cerebrovascular reconstruction for MMD.Higher age and left-sided surgery are clinical predictive factors of postoperative CHS.