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[1]祝剑虹,丁可,董国俊,等.烟雾病血管吻合术后早期颅高压的产生和治疗策略[J].医学研究与战创伤救治(原医学研究生学报),2022,24(4):373-376.[doi:10.3969/j.issn.1672-271X.2022.04.008]
　ZHU Jian-hong,DING Ke,DONG Guo-jun,et al.Generation and treatment strategy of early intracranial hypertension after vascular anastomosis in moyamoya disease[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2022,24(4):373-376.[doi:10.3969/j.issn.1672-271X.2022.04.008]
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烟雾病血管吻合术后早期颅高压的产生和治疗策略()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第24卷
期数:
2022年4期
页码:
373-376
栏目:
临床研究
出版日期:
2022-08-30

文章信息/Info

Title:
Generation and treatment strategy of early intracranial hypertension after vascular anastomosis in moyamoya disease
作者:
祝剑虹; 丁可; 董国俊; 张力; 茅磊; 沈娟红
作者单位：210002南京，东部战区总医院（原南京军区南京总医院）神经外科（祝剑虹、丁可、董国俊、张力、茅磊）；210014南京，南京体育学院运动健康学院（沈娟红）
Author(s):
ZHU Jian-hong1; DING Ke1; DONG Guo-jun1; ZHANG Li1; MAO Lei1; SHEN Juan-hong2
（1.Department of Neurosurgery，General Hospital of Eastern Theater Command, PLA, Nanjing 210002, Jiangsu, China；2.Institute of Physical Education，Nanjing Sport Institute, Nanjing 210014, Jiangsu, China）
关键词:
烟雾病; 暂时神经功能障碍; 颅内高压; 血管吻合; 限制性引流
Keywords:
moyamoya disease;  transient neurological dysfunction;  intracranial hypertension;  vascular anastomosis;  restrictive drainage
分类号:
R651.12
DOI:
10.3969/j.issn.1672-271X.2022.04.008
文献标志码:
A
摘要:
目的烟雾病患者血管吻合术后早期部分患者可出现频繁呕吐，头痛，食欲不振，测颅内压均可见不同程度的颅内压升高，文中探讨这类非感染和梗塞性颅内压升高发生的特点和可能的原因，并总结基本的治疗策略。方法回顾性分析2019年2月-2020年12月东部战区总医院收治的行颞浅动脉-大脑中动脉吻合的烟雾病患者42例的临床资料，经腰穿测其颅内压及脑脊液常规和生化指标，判断是否存在颅内感染；并以头颅MRI及CT血管成像/灌注成像(CTA/CTP)检查判断是否出现脑梗死。对于明确颅内压升高的患者，探讨抗凝、微弱脱水降低颅内压、扩张脑血管、限制性腰大池引流及营养支持、止吐等治疗的有效性。结果术后出现颅内压增高症状的共15例，平均（246.7±28.0）mmH2O，脑脊液化验结果白细胞2~110个，红细胞2~15 000个，均未见明显颅内感染，MRI未见明显脑梗死及脑组织水肿，CT血管成像可见血管吻合通畅，脑组织灌注未见减弱。结论烟雾病血管吻合术后相当一部分早期神经功能障碍的患者可能存在颅内压增高，无明显感染及脑梗死征象，可能与脑脊液理化性质改善有关，限制性腰大池引流联合营养及对症支持等治疗则能较快缓解患者症状，改善颅内压，因此腰大池引流和支持治疗可有效地治愈这类良性颅高压。
Abstract:
ObjectiveIn the early stage after vascular anastomosis, some patients with moyamoya disease have frequently vomiting, headache and loss of appetite. Different degrees of intracranial pressure increase can be seen by lumbar puncture. This paper will explore the characteristics and possible causes of this kind of non infectious and infarct intracranial pressure increase, and summarize the basic treatment strategies.Methods42 patients with moyamoya disease with superficial temporal artery middle cerebral artery anastomosis in General Hospital of Eastern Theater Command from February 2019 to December 2020 were enrolled. Their intracranial pressure and routine and biochemical indexes of cerebrospinal fluid were measured by lumbar puncture to judge whether there was intracranial infection. Brain MRI and CTA /CTP were used to determine whether there was cerebral infarction. For patients with elevated intracranial pressure, we explored the effectiveness of anticoagulation, weak dehydration, reducing intracranial pressure, expanding cerebral vessels, restrictive lumbar cistern drainage, nutritional support and antiemesis.ResultsA total of 15 patients with symptoms of increased intracranial pressure after operation. The intracranial pressure of all patients were increased, with an average of （246.7±28.0） mmH2O. The cerebrospinal fluid test results showed that there were 2-110 leukocytes and 2-15 000 erythrocytes, and there was no obvious intracranial infection. There was no obvious cerebral infarction and brain tissue edema on MRI. CTA showed smooth vascular anastomosis and no weakening of brain tissue perfusion.ConclusionA considerable number of patients with moyamoya disease after vascular anastomosis may be increased intracranial pressure without obvious signs of infection and cerebral infarction, which may be related to the improvement of physical and chemical properties of cerebrospinal fluid. Simple anticoagulation, expansion of cerebral vessels and glycerol fructose dehydration can not significantly improve the symptoms and intracranial pressure, and may even aggravate the symptoms of patients, restrictive lumbar cistern drainage combined with nutrition and symptomatic support can quickly alleviate patients’ symptoms and improve intracranial pressure. Therefore, lumbar cistern drainage and support treatment can effectively cure this kind of benign intracranial hypertension.

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更新日期/Last Update: 2022-09-06