High variance of intraoperative blood pressure predicts early cerebral infarction after revascularization surgery in patients with Moyamoya disease
High variance of intraoperative blood pressure predicts early cerebral infarction after revascularization surgery in patients with Moyamoya disease
复制标题
术中血压的高方差预测烟雾病患者血运重建术后早期脑梗死
DOI：
10.1007/s10143-019-01118-z
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发表时间：
2020-04-01
影响因子：
2.8
通讯作者：
Zhao, Jizong
中科院分区：
文献类型：
--
作者：
Li, Jiaxi;Zhao, Yahui;Zhao, Jizong
很少有研究集中于烟雾病(MMD)患者的术中血压。我们的目的是阐明它是否与血运重建后早期脑梗塞有关。我们回顾了2011年至2018年北京天坛医院收治的烟雾病患者的临床资料，并将术后早期经放射学证实的脑梗塞患者纳入分析。对照组根据年龄、性别和血管重建方式按1：5的比例进行匹配。收集并分析围手术期临床因素和术中血压数据。经CT或MRI证实术后早期脑梗塞52例(3.5%)，年龄38.46 ± 11.70，男性26例(50.0%)。平均实际变异性-收缩压(OR3.29，p= 0.003)、平均真实变异性-舒张压(OR4.10，p= 0.005)、平均动脉压(OR4.08，p= 0.004)、最大舒张压下降(OR1.08，p= 0.003)和平均动脉压下降(OR1.06，p= 0.004)与术后早期脑梗塞有关。在大面积脑梗塞患者中，舒张压最大下降(OR1.11，p= 0.004)和平均动脉压(OR1.11，p= 0.003)是独立的危险因素，而收缩压(OR3.9，p<； 0.001)、舒张压(OR4.69，p= 0.008)和平均动脉压(MAP)(OR4.72，p= 0.003)与ARV显著相关。术中血压变化大和血压急剧下降是MMD患者行血管重建术后发生脑梗塞的独立危险因素。建议保持术中血压稳定，以预防MMD患者术后早期脑梗塞。
Few studies focused on the intraoperative blood pressure in Moyamoya disease (MMD) patients. We aimed to clarify whether or not it relates to early cerebral infarction after revascularization. We reviewed a retrospective cohort of Moyamoya disease from 2011 to 2018 in Beijing Tiantan Hospital, and patients with radiologically confirmed early postoperative infarction were included in the analysis. Controls were matched based on age, sex, and revascularization modality at a ratio of 1:5. Perioperative clinical factors and intraoperative blood pressure data were collected and analyzed. A total of 52 patients out of 1497 revascularization surgeries (3.5%) who experienced CT or MRI confirmed early postoperatively cerebral infarction, aged 38.46 ± 11.70; 26 were male (50.0%). Average real variability (ARV)-systolic blood pressure (SBP) (OR 3.29,p= 0.003), ARV-diastolic blood pressure (DBP) (OR 4.10,p= 0.005), ARV-mean arterial pressure (MAP) (OR 4.08,p= 0.004), and the maximum drops of DBP (OR 1.08,p= 0.003) and MAP (OR 1.06,p= 0.004) were associated with early postoperative infarction. In patients who experienced massive cerebral infarction, the maximum drops of DBP (OR 1.11,p= 0.004) and MAP (OR 1.11,p= 0.003) are independent risk factors, whereas ARVs of SBP (OR 3.90,p< 0.001), DBP (OR 4.69,p= 0.008), and MAP (OR 4.72,p= 0.003) are significantly associated with regional infarction. High variance of intraoperative blood pressure and drastic blood pressure decline are independent risk factors for postoperative infarction in MMD patients who underwent revascularization surgery. Maintaining stable intraoperative blood pressure is suggested to prevent early postoperative cerebral infarction in MMD patients.