背景:脑高灌注综合征(CHS)被认为是烟雾病(MMD)搭桥手术后的并发症。然而,CHS的发病率尚未准确报告,并且在与之相关的风险因素上没有达成共识。
目的:本研究的目的是确定用于治疗成年MMD患者的手术联合血运重建术后CHS的相关危险因素。
目的:评估血运重建术后MMD患者CHS的发生频率和特点。
方法:对2021年1月至2022年11月接受联合血运重建的患者进行回顾性分析。记录术前临床特征和影像学特征。术后CHS检查。进行多因素logistic回归分析以确定CHS的危险因素。
结果:本研究共纳入133例患者(141个半球)。术后观察到28个半球(19.8%)的CHS,包括20个半球的局灶性脑高灌注综合征(FCHS)(14.2%),4个(4.4%)半球出血,4个(4.4%)半球癫痫发作。多因素logistic回归分析结果显示术前高血压(OR3.940,95%CI1.275~12.180,p=0.017),合并血运重建后,脑出血发作(OR5.489,95%CI1.443〜20.884,p=0.013)和较高的Hct水平(OR1.166,95%CI1.047〜1.298,p=0.005)与CHS显着相关。
结论:术前高血压,脑出血发病,高Hct水平是联合血运重建后CHS的独立危险因素。
BACKGROUND: Cerebral hyperperfusion syndrome (CHS) is known as a complication after bypass surgery for Moyamoya disease (MMD). However, the incidence of CHS has not been accurately reported, and there is no consensus on the risk factors associated with it.
OBJECTIVE: The aim of this study was to determine the risk factors associated with postoperative CHS after surgical combined revascularization used to treat adult patients with MMD.
OBJECTIVE: To assess the frequency and characteristics of CHS in patients with MMD after revascularization operations.
METHODS: Patients who received combined revascularization from Jan 2021 to Nov 2022 were retrospectively reviewed. Preoperative clinical characteristics and radiographic features were recorded. Postoperative CHS after surgery were examined. Multivariate logistic regression analyses were performed to identify the risk factors for CHS.
RESULTS: A total of 133 patients (141 hemispheres) were included in this study. Postoperative CHS were observed in 28 hemispheres (19.8%), including focal cerebral hyperperfusion syndrome (FCHS) in 20 hemispheres (14.2%), hemorrhage in 4 (2.8%) hemispheres, seizures in 4 (2.8%) hemispheres. The results of multivariate logistic regression analysis indicated that preoperative hypertension (OR 4.705, 95% CI 1.323 ~ 12.554, p = 0.014), cerebral hemorrhage onset (OR 5.390, 95% CI 1.408 ~ 20.642, p = 0.014) and higher Hct level (OR 1.171, 95% CI 1.051 ~ 1.305, p = 0.004) were significantly associated with CHS after combined revascularization.
CONCLUSIONS: Preoperative hypertension, cerebral hemorrhage onset, and higher Hct level were independent risk factors for CHS after combined revascularization.