术后神经功能缺损损害了烟雾病(MMD)患者血运重建手术的总体结果。dl-3-正丁基苯酞(NBP)在中国被批准用于治疗缺血性中风。这项初步研究评估了NBP对MMD患者围手术期中风和神经功能缺损的影响。
作者研究了患者在其机构接受MMD联合血运重建手术的案例,有或没有NBP管理。整个研究组包括164名患者(213个手术治疗的半球),包括49例接受NBP(25mg,每日2次)治疗7天的患者.比较了49个倾向评分匹配的病例对是否接受NBP治疗的围手术期中风和短暂性神经功能缺损(TND)的发生率以及神经功能缺损的严重程度。还根据发病类型和术前神经状态进行了亚组分析,以确定可能从NBP给药中受益的患者的具体特征。
在整个队列中,接受NBP和未接受NBP的患者的基线特征在术前卒中和改良Rankin量表(mRS)评分方面存在差异.在49个倾向得分匹配的对中,术后11例患者发生卒中,21例患者发生TND,两组发病率无显著差异。然而,NBP治疗组的TND较轻(p=0.01).手术后1个月,在接受NBP治疗的患者中,神经系统转归更有利(p=0.001),无残疾恢复率更高(p<0.001).经历了神经功能改善的患者数量,与术前功能相比,用mRS测量,NBP组高于非NBP组(p<0.001)。多变量分析显示,NBP与TND严重程度降低相关(OR0.28,p=0.02),改善神经功能(OR65.29,p=0.04),术后mRS评分较低(OR0.06,p<0.001)。NBP的这些有益作用在缺血型MMD和术前mRS评分为2或更高的患者中仍然显著。
术后给予NBP可以减轻MMD血管重建术后的围手术期神经功能缺损,尤其是在缺血性MMD和不良术前状态的患者中。这项研究的结果表明,可能需要进行随机对照试验来评估NBP对MMD患者的潜在益处。
Postoperative neurological deficits impair the overall outcome of revascularization surgery for patients with moyamoya disease (MMD). dl-3-n-butylphthalide (NBP) is approved for the treatment of ischemic stroke in China. This pilot study evaluated the effect of NBP on perioperative stroke and neurological deficits in patients with MMD.
The authors studied cases in which patients underwent combined revascularization surgery for MMD at their institution, with or without NBP administration. The overall study group included 164 patients (213 surgically treated hemispheres), including 49 patients who received NBP (25 mg twice daily) for 7 postoperative days. The incidence of perioperative stroke and transient neurological deficit (TND) and the severity of neurological deficits were compared between 49 propensity score-matched case pairs with or without NBP treatment. Subgroup analyses by type of onset and preoperative neurological status were also performed to determine specific characteristics of patients who might benefit from NBP administration.
In the overall cohort, baseline characteristics differed with respect to preoperative stroke and modified Rankin Scale (mRS) score between patients who received NBP and those who did not receive it. In the 49 propensity score-matched pairs, postoperative stroke was observed in 11 patients and TND occurred in 21 patients, with no significant difference in incidence between the 2 groups. However, the TND was less severe in the NBP-treated group (p = 0.01). At 1 month after surgery, the neurological outcome was more favorable (p = 0.001) and the disability-free recovery rate was higher in patients with NBP treatment (p < 0.001). The number of patients who experienced an improved neurological function, compared to preoperative function, as measured by mRS, was greater in the NBP group than in the no-NBP group (p < 0.001). Multivariable analysis revealed that NBP administration was associated with decreased severity of TND (OR 0.28, p = 0.02), improved neurological function (OR 65.29, p = 0.04), and lower postoperative mRS score (OR 0.06, p < 0.001). These beneficial effects of NBP remained significant in ischemic type MMD and patients with preoperative mRS scores of 2 or greater.
Postoperative administration of NBP may alleviate perioperative neurological deficits after revascularization surgery for MMD, especially in patients with ischemic MMD and unfavorable preoperative status. The results of this study suggest that randomized controlled trials to assess the potential benefit of NBP in patients with MMD may be warranted.