烟雾病联合血运重建术术后高灌注综合征非手术技术危险因素分析

Analysis of non⁃operative technical risk factors for cerebral hyperperfusion syndrome after combined revascularization techniques with moyamoya disease

目的:分析成年烟雾病患者(MMD)联合血运重建术后高灌注综合征(CHS)的危险因素。方法:回顾性收集2019年5月至2022年3月行联合脑血运重建术的成年MMD患者81例(92侧)的术前、术中及术后相关临床资料,根据患者术后是否并发CHS将患者分为CHS组(31侧)和非CHS组(61侧),采用单因素和多因素Logistic回归分析术后CHS的危险因素。结果:81例患者的92侧脑联合血运重建术均成功,术中及术后显示桥血管均通畅。术后31侧(33.70%)出现CHS,且2周内经保守治疗症状完全恢复。单因素分析结果显示两组在手术侧别、术前红细胞比积、术前相对脑血容量(rCBV)、术中最低二氧化碳分压(PaCO_(2))和术后第1日总蛋白水平的差异有统计学意义(均P<0.05);进一步多因素Logistic回归分析显示左侧手术(OR=4.586,95%CI:1.484~14.167,P=0.008)、术中最低PaCO_(2)较低(OR=0.756,95%CI:0.616~0.928,P=0.007)、术前rCBV较高(OR=1.045,95%CI:1.007~1.085,P=0.022)和术后第1日总蛋白较低(OR=0.791,95%CI:0.666~0.938,P=0.007)是MMD患者联合血运重建术后并发CHS的独立危险因素。结论:左侧手术、术中最低PaCO_(2)较低、术前rCBV较高和术后第1日总蛋白较低是MMD患者联合血运重建术后并发CHS的独立危险因素。

Objective:To analyze the risk factors of cerebral hyperperfusion syndrome(CHS)in adult pa⁃tients with moyamoya disease(MMD)after combined revascularization.Methods:The preoperative,intraoperative and postoperative clinical records of 81 adult patients with MMD(92 sides)who under⁃went combined cerebral revascularization from May 2019 to March 2022 were retrospectively collect⁃ed.Patients were divided into CHS group(31 sides)and non⁃CHS group(61 sides)according to the occurrence of CHS after surgery.Univariate and multivariate logistic regression were used to analyze the risk factors of CHS after surgery.Results:The 92 sides of the brain combined revascularization were successfully reconstructed in 81 patients,and the bridging vessels were unobstructed both intra⁃operatively and postoperatively.CHS appeared on 31 sides(33.70%)after surgery,and the symp⁃toms recovered completely within 2 weeks with conservative treatment.Univariate analysis showed that there were significant differences between the two groups in surgical side,preoperative hemato⁃crit,preoperative relative cerebral blood volume(rCBV),intraoperative minimum partial pressure of carbon dioxide(PaCO_(2))and total protein levels on postoperative day 1(all P<0.05).Further multi⁃variate logistic regression analysis showed that the operation on the left side(OR=4.586,95%CI:1.484⁃14.167,P=0.008),decreased intraoperative minimum PaCO_(2)(OR=0.756,95%CI:0.616⁃0.928,P=0.007),higher preoperative rCBV(OR=1.045,95%CI:1.007⁃1.085,P=0.022)and lower total protein levels on postoperative day 1(OR=0.791,95%CI:0.666⁃0.938,P=0.007)were independent risk factors for CHS after combined revascularization techniques with MMD.Con⁃clusion:The operation on the dominant hemisphere,decreased intraoperative minimum PaCO_(2),high⁃er preoperative rCBV and lower total protein levels on postoperative day 1 were independent risk fac⁃tors for CHS after combined revascularization in adult⁃onset moyamoya patients.