摘要
目的观察颅内外血管重建术治疗烟雾病对患者并发脑卒中的防治效果。方法本研究为前瞻性随机对照研究,选取2020年1月至2021年12月在南阳医学高等专科学校附属中医院手术室行手术治疗的80例烟雾病患者,男30例,女50例,年龄(45.34±0.24)岁,年龄范围为35~55岁。采用抽签法将患者分为间接治疗组(n=25)、直接治疗组(n=25)及联合治疗组(n=30),间接治疗组患者行脑—硬脑膜—动脉血管融通术(EDAS)治疗,直接治疗组患者行颞浅动脉—大脑中央动脉分支直接吻合术(STA-MCA)治疗,联合治疗组患者行EDAS联合STA-MCA治疗,比较三组患者治疗前后的脑血流动力改善情况、脑神经功能改善情况、侧支循环改善情况、并发症发生情况。结果联合治疗组脑血流量[(1.32±0.81)ml/min]高于间接治疗组[(1.05±0.23)ml/min]及直接治疗组[(0.94±0.25)ml/min]、脑血容量[(1.45±0.88)ml/100 g]高于间接治疗组[(1.15±0.16)ml/100 g]及直接治疗组[(1.16±0.14)ml/100 g]、血流平均通过时间[(4.37±0.14)s]低于间接治疗组[(4.81±0.86)s]及直接治疗组[(4.82±0.85)s]、改良Rakin量表评分[(2.05±0.33)分]低于间接治疗组[(2.57±0.85)分]及直接治疗组[(2.58±0.82)分]、卒中量表评分[(20.03±0.32)分]低于间接治疗组[(20.47±0.81)分]及直接治疗组[(20.45±0.83)分]、改良Bathel指数量表评分[(65.72±0.85)分]高于间接治疗组[(65.28±0.25)分]及直接治疗组[(65.33±0.21)分]、侧支循环改善率[86.7%(26/30)]高于间接治疗组[68.0%(17/25)]及直接治疗组[72.0%(18/25)],差异均有统计学意义(P<0.05)。联合治疗组、间接治疗组及直接治疗组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论STA-MCA联合EDAS治疗可进一步促进其脑血流动力学及脑神经功能恢复,对改善患者侧支循环具有积极作用。
Objective To observe the preventive and therapeutic effect of intracranial and extracranial vascular reconstruction on moyamoya disease complicated with stroke.Methods This study was a prospective randomized controlled study,a total of 80 patients with moyamoya disease who received Operating Room department of the Affiliated Hospital of Traditional Chinese Medicine of Nanyang Medical College from January 2020 to December 2021,aged(45.34±0.24)years old,ranging form 35 to 55 years old.The patients were divided into indirect treatment group(n=25),direct treatment group(n=25)and combined treatment group(n=30),the patients in the indirect treatment group were treated with encephaloduroarteriosynangiosis(EDAS),while the patients in the direct treatment group were treated with superficial temporal artery-middle cerebral artery anastomosis(STA-MCA),EDAS combined with STA-MCA was used in the combined treatment group.The improvement of cerebral blood flow and nerve function were compared among the three groups before and after treatment,and the improvement of collateral circulation and postoperative complications were compared after 8-months follow-up.Results The cerebral blood flow in the combined treatment group[(1.32±0.81)ml/min]was higher than that in the indirect treatment group[(1.05±0.23)ml/min]and the direct treatment group[(0.94±0.25)ml/min],cerebral blood volume[(1.45±0.88)ml/100 g]was higher than that in the indirect treatment group[(1.15±0.16)ml/100 g]and the direct treatment group[(1.16±0.14)ml/100 g],cerebral blood flow[(4.37±0.14)s]was lower than that in the indirect treatment group[(4.81±0.86)s]and the direct treatment group[(4.82±0.85)s],the score of modified Rakin scale[(2.05±0.33)scores]was lower than that in the indirect treatment group[(2.57±0.85)scores]and the direct treatment group[(2.58±0.82)scores],the score of stroke scale[(20.03±0.32)scores]was lower than that in the indirect treatment group[(20.47±0.81)scores]and the direct treatment group[(20.45±0.83)scores],the score of Modified Bathel Index[(65.72±0.85)scores]was higher than that in the indirect treatment group[(65.28±0.25)scores]and the direct treatment group[(65.33±0.21)scores],and the improvement rate of collateral circulation[86.7%(26/30)]was higher than that in the indirect treatment group[68.0%(17/25)]and the direct treatment group[72.0%(18/25)],the differences were statistically significant(P<0.05).The complication rate of the combined treatment group,the indirect treatment group and the direct treatment group was compared,the differences was not statistically significant(P>0.05).Conclusions Combination of STA-MCA and EDAS can further improve the recovery of brain Hemodynamics and nerve function,and has a positive effect on improving collateral circulation.
作者
杨双
乔珊
马绍阳
沙丹
宋雪
Yang Shuang;Qiao Shan;Ma Shaoyang;Sha Dan;Song Xue(Department of Operating Room,Affiliated Hospital of Traditional Chinese Medicine of Nanyang Medical College,Nanyang 473000,China)
出处
《中国临床实用医学》
2023年第1期31-35,共5页
China Clinical Practical Medicine
基金
河南省医学科技攻关项目(2021003321)。
关键词
烟雾病
颅内外血管重建术
脑血流动力学
脑神经功能
侧支循环
Moyamoya disease
Intracranial and extracranial vascular reconstruction
Cerebral hemodynamics
Brain nerve function
Collateral circulation
