烟雾病围手术期卒中危险因素分析

Risk factors for perioperative stroke in moyamoya disease

摘要:

目的 脑血运重建术是目前烟雾病外科治疗的有效方式，但围手术期卒中发生率可达15.6%，且这部分患者预后不佳。该研究拟分析烟雾病围手术期卒中发生的危险因素，进而指导临床加强围手术期管理，以降低围手术期卒中发生率并改善患者预后。方法 纳入中南大学湘雅医院神经外科2011年1月—2021年4月手术治疗102例烟雾病患者的基本信息和影像学资料，采用多因素Logistic回归分析筛选该类患者围手术期卒中发生的危险因素。结果 102例烟雾病患者的平均发病年龄为28.22岁，共行118侧脑血运重建术，包括51次联合血运重建术和67次间接血运重建术。烟雾病围手术期卒中发生率为6.78%，其中缺血性卒中5例，出血性卒中3例，无死亡病例发生。多因素Logistic回归分析显示，高铃木分期(OR: 9.814；95%CI: 1.655~58.204, P=0.012)、低脑梗死评分(OR: 0.646；95%CI: 0.440~0.948, P=0.026)及脑白质高信号（WMHs）(OR: 7.302；95%CI: 1.203~44.310, P=0.031)是烟雾病围手术期卒中发生的危险因素。结论 具有高铃木分期、低脑梗死评分及WMHs特征的烟雾病患者围手术期卒中发生风险高，需对这些患者严格管理。

Abstract:

Objective Cerebral revascularization is an effective method for the surgical treatment of moyamoya disease， but the incidence rate of perioperative stroke is as high as 15.6% and such patients tend to have poor prognosis. This study aims to identify the risk factors for perioperative stroke in moyamoya disease and provide guidance to strengthen perioperative management， so as to reduce the incidence rate of perioperative stroke and improve the prognosis of patients.Methods General information and imaging data were collected from 102 patients with moyamoya disease who underwent surgical treatment in Department of Neurosurgery， Xiangya Hospital of Central South University， from January 2011 to April 2021， and a multivariate logistic regression analysis was used to screen out the risk factors for perioperative stroke.Results The 102 patients had a mean age of onset of 28.22 years， and cerebral revascularization was performed for 118 sides， including 51 times of combined revascularization and 67 times of indirect revascularization. The incidence rate of perioperative stroke was 6.78% for moyamoya disease， and there were 5 patients with ischemic stroke and 3 with hemorrhagic stroke. No death was observed. The multivariate logistic regression analysis showed that high Suzuki stage （odds ratio ［OR］ = 9.814， 95% confidence interval ［CI］： 1.655-58.204， P = 0.012）， low cerebral infarction score （OR = 0.646， 95% CI： 0.440-0.948， P = 0.026）， and white matter hyperintensities （OR = 7.302， 95% CI： 1.203-44.310， P = 0.031） were the risk factors for perioperative stroke in moyamoya disease.Conclusions For moyamoya disease， patients with a relatively high Suzuki stage， a relatively low cerebral infarction score， and white matter hyperintensities tend to have a high risk of perioperative stroke， and such patients should be strictly managed to reduce the incidence rate of perioperative stroke.