儿童缺血性烟雾病围手术期管理及对预后的影响

Perioperative management and effect on prognosis in children with ischemic moyamoya disease

摘要:

目的 探讨儿童缺血性烟雾病围手术期管理的可行方案以及围手术期缺血事件对临床预后的影响。方法 回顾性分析2011年5月至2017年12月共28例36侧儿童缺血性烟雾病患儿围手术期的相关临床资料以及随访资料；因2015年6月后综合改进围手术期管理方案，故以此时间点将患者分为围手术期管理改进前的A组和改进后的B组，并比较两组围手术期缺血事件的差异；术后6个月时对患者临床症状变化进行评估。结果 A组（4/10）和B组（2/26）的围手术期缺血事件发生的差异有统计学意义（P<0.05）；术后6个月时86.11%（31/36）的术侧临床症状好转；临床症状无明显改变或恶化的术侧有5侧，其中4侧有围手术期缺血事件的病史占临床症状无明显改变或恶化总数的80%（4/5）；而围手术期发生缺血事件的患者中仅有33.3%（2/6）术侧预后临床症状好转。结论 通过综合改进围手术期管理方案后能够有效降低儿童缺血性烟雾病患者围手术期缺血事件的发生；围手术期发生缺血事件可能是患者术后临床症状无明显改变或恶化的主要原因。

Abstract:

Objective To explore the feasibility of perioperative management of ischemic moyamoya disease in children and to discuss the effect of perioperative ischemic events on clinical prognosis. Methods Retrospectively analyzed the clinical data and follow-up data of 28 children with 36 sides operation with ischemic moyamoya disease from May 2011 to December 2017 in our hospital. In view of the comprehensive improvement of perioperative management plan after June 2015, the patients were divided into A group and improved group. The difference of perioperative ischemic events between the two groups was evaluated, and the clinical symptoms were evaluated at 6 months after operation. Results The difference of perioperative ischemic events between group A (4/10) and group B (2/26) was statistically significant (P<0.05). At 6 months after operation, the clinical symptoms of 86.11% (31/36) improved There were 5 cases with no significant change or deteriorate of clinical symptoms, including 4 cases had a history of ischemic events during perioperative period, which accounted for 80% of the total (4/5). Only 33.3% (2/6) of the patients had surgical side prognosis and clinical symptoms improved, which have occurred perioperative ischemic events. Conclusions Through comprehensive improvement of perioperative management plan, we can effectively reduce perioperative ischemic events in children with ischemic moyamoya disease. Perioperative ischemic events may be the main reason for no significant changes or deteriorate of clinical symptoms.