临床神经外科杂志2026，Vol.23Issue(4)：406-411,417,7.DOI:10.3969/j.issn.1672-7770.2026.04.008
成人烟雾病颞浅动脉-大脑中动脉搭桥术后出血性高灌注综合征的临床特点及危险因素分析
Clinical features and risk factors of hyperperfusion hemorrhage after STA-MCA bypass in adult moyamoya disease
摘要
Abstract
Objective To investigate the clinical characteristics and risk factors of hyperperfusion-related hemorrhage after superficial temporal artery-middle cerebral artery(STA-MCA)bypass in adult patients with Moyamoya disease(MMD).Methods The clinical data of 382 adult MMD patients who underwent STA-MCA bypass at Nanjing Brain Hospital from November 2017 to May 2025 were analyzed retrospectively.Patients were divided into the hemorrhagic cerebral hyperperfusion syndrome(hCHS)group and the non-hCHS group,based on the occurrence of hCHS within 2 weeks after surgery.The modified Rankin scale(mRS)was used to evaluate the clinical prognosis of patients half a year postoperatively.Univariate analysis and multivariate Logistic regression models were applied to identify the risk factors for postoperative hCHS in MMD patients.Results Among the 382 patients,18 developed hCHS,including 4 cases of subarachnoid hemorrhage(one occurring intraoperatively),11 cases of intracerebral hemorrhage(ICH),and 3 cases of combined SAH and ICH.Half a year after surgery,361 patients had an mRS score of 0-2,while 21 had a score of 3-6.The mRS score was 2.5(1,3.25)in the hCHS group,with 50%(9/18)of patients achieving an mRS score of 0～2.In the non-hCHS group,the mRS score was 1(0,1),with 96.70%(352/364)of patients having an mRS score of 0-2.There was a statistically significant difference in the mRS distribution between the two groups(Z=-4.691,P<0.001).Univariate analysis showed that the two groups differed significantly in terms of essential hypertension,the initial clinical presentation of cerebral infarction,and Suzuki stage.Multivariate Logistic regression analysis revealed that essential hypertension(OR=3.695,95%CI=1.274-10.716,P=0.016),initial symptom of cerebral infarction(OR=2.995,95%CI=1.030-8.706,P=0.044)and high Suzuki stage(OR=1.700,95%CI=1.002-2.885,P=0.049)were independent risk factors for hCHS after STA-MCA bypass in adult MMD patients.Conclusions hCHS mostly occurs within one week after STA-MCA bypass,and the prognosis of patients with hCHS is significantly worse than that of non-hCHS patients.Adult MMD patients with essential hypertension,initial clinical presentation of cerebral infarction or advanced Suzuki stage have a higher tendency to develop hCHS after STA-MCA bypass.关键词
烟雾病/脑血管重建术/出血性高灌注综合征/疾病特征/危险因素Key words
moyamoya disease/cerebral revascularization/hemorrhagic cerebral hyperperfusion syndrome/disease characteristic/risk factor分类
医药卫生引用本文复制引用
余志强,张光绪,赵金兵,陈立久,何升学..成人烟雾病颞浅动脉-大脑中动脉搭桥术后出血性高灌注综合征的临床特点及危险因素分析[J].临床神经外科杂志,2026,23(4):406-411,417,7.基金项目
江苏省卫生健康委医学科研项目(H2023143) （H2023143）
