烟雾病患者血管搭桥术后使用阿司匹林预防脑梗死的回顾性研究

目的探讨阿司匹林在烟雾病(MMD)血管搭桥术后脑梗死发生中的预防作用。方法回顾性分析2014年1月—2019年10月南昌大学第一附属医院神经外科采取血管搭桥术治疗的565例MMD患者的临床资料，根据术后是否应用阿司匹林将其分为阿司匹林组（406例)和未应用阿司匹林组(159例，对照组)，统计两组患者术后围手术期内脑梗死和术后3个月内脑出血的发生情况等，以明确阿司匹林在MMD术后脑梗死发生中的作用。入院、出院时和术后3个月的神经功能状况采用改良Rankin量表评分（mRS)评估。结果565例患者中，26例诊断为术后脑梗死，其中阿司匹林组术后围手术期内脑梗死的发生率为3.2%（13/406），术后3个月内脑出血的发生率为1.2%（5/406）；对照组术后围手术期内脑梗死的发生率为8.2%（13/159），术后3个月内脑出血的发生率为0.6%（1/159）。 两组患者的性别、年龄、高血压史等差异均无统计学意义（均P＞0.05）。两组患者术后围手术期内发生脑梗死、短暂性脑缺血发作、出院mRS评分及出院时神经功能恶化的差异均有统计学意义(均P＜0.05)；而两组患者术后3个月内脑出血、术后3个月mRS评分、术后3个月神经功能等差异均无统计学意义（均P＞0.05）。单因素分析结果显示，患者的年龄、高血压及糖尿病史、大脑后动脉狭窄或闭塞等是MMD术后发生脑梗死的可能影响因素（均P＜0.05）。多因素Logistic回归分析结果显示，高血压史（OR=0.204，95%CI：0.067～0.623，P=0.005）、梗死型MMD（OR=0.084，95%CI：0.025～0.277，P＜0.001）、左侧血管搭桥（OR=0.234，95%CI：0.076～0.720，P=0.011）、大脑后动脉狭窄或闭塞（OR=0.008，95%CI：0.002～0.037，P＜0.001）是MMD术后脑梗死的危险因素，而术后应用阿司匹林（OR=2.897，95%CI：1.024～8.197，P=0.045）是预防MMD术后发生脑梗死的保护因素。结论MMD患者血管搭桥术后常规应用阿司匹林可降低急性脑梗死的发生。

ObjectiveTo investigate the preventive effect of aspirin on cerebral infarction after vascular bypass grafting in moyamoya disease(MMD). MethodsClinical data of 565 patients with MMD who received vascular bypass grafts in the Department of Neurosurgery, the First Affiliated Hospital of Nanchang University from January 2014 to October 2019 were analyzed retrospectively. They were divided into aspirin group(406 cases) and non-aspirin group(159 cases, control group) according to whether aspirin was used after surgery. In order to clarify the role of aspirin in the occurrence of cerebral infarction after MMD, the incidence of cerebral infarction during perioperative period and cerebral hemorrhage within 3 months after surgery in the two groups was statistically analyzed. Neurological function at admission, discharge, and 3 months after surgery was assessed by using modified Rankin scale(mRS) score. ResultsAmong the 565 patients, 26 were diagnosed with postoperative cerebral infarction. The incidence of perioperative cerebral infarction was 3.2%(13/406) in the aspirin group, and the incidence of cerebral hemorrhage was 1.2%(5/406) within 3 months after surgery. In the control group, the incidence of cerebral infarction in the perioperative period was 8.2%(13/159), and the incidence of cerebral hemorrhage in the 3 months after surgery was 0.6%(1/159). There were no significant differences in gender, age and history of hypertension between 2 groups(all P>0.05). There were statistically significance in perioperative cerebral infarction, transient ischemic attack, mRS Score at discharge and neurological deterioration at discharge between the two groups(all P<0.05). There were no significant differences in cerebral hemorrhage 3 months after surgery, mRS score 3 months after surgery and neurological function 3 months after surgery between the two groups(all P>0.05). Univariate analysis showed that patients’ age, history of hypertension and diabetes, and posterior cerebral artery stenosis or occlusion were possible influencing factors for cerebral infarction after MMD(all P<0.05). Multivariate Logistic regression analysis showed that history of hypertension(OR=0.204, 95%CI:0.067-0.623,P=0.005), infarct MMD(OR=0.084, 95%CI:0.025-0.277,P<0.001), left vascular bypass(OR=0.234, 95%CI:0.076-0.720,P=0.011), posterior cerebral artery stenosis OR occlusion(OR=0.008,95%CI:0.002-0.037,P<0.001) was a risk factor for cerebral infarction after MMD, and postoperative aspirin(OR=2.897,95%CI:1.024-8.197,P=0.045) was a protective factor for preventing cerebral infarction after MMD. ConclusionRoutine use of aspirin after vascular bypass surgery can reduce the incidence of acute cerebral infarction in patients with MMD.