烟雾病血运重建术后非感染性发热的发病率与危险因素分析

doi:10.3969/j.issn.1673-5765.2022.07.011

摘要/Abstract

摘要：

目的探索烟雾病（moyamoya disease，MMD）患者血运重建术后非感染性发热的发病率、临床特点及其影响因素。

方法回顾性分析2019年11月-2021年2月连续接受血运重建术治疗的MMD患者，收集患者人口学信息、MMD发病类型、既往病史、Suzuki分期、烟雾血管（前后循环）、手术类型和侧别、手术时长、术后血常规检查、术后体温和出院时mRS（＞2分为预后不良）等临床信息。以术后14 d内的是否出现非感染性发热（1次体温>38 ℃且无系统性感染证据）分为发热组和无发热组，采用多因素logistic回归分析术后发热的影响因素。

结果共纳入110例MMD患者，累及143个大脑半球，91例次（63.6%）出现术后非感染性发热，其中81例次（89.0%）发生于术后2 d内。单因素分析发现，术后发热组中成人比例（74.7% vs. 88.5%，P=0.049）、男性比例（37.4% vs. 63.5%，P=0.003）、术后红细胞压积[（33.6±4.2）% vs.（35.8±4.3）%，P=0.004）]、红细胞计数[（3.9±0.5）×10¹²/L vs.（4.1±0.5）×10¹²/L，P=0.004]和白细胞计数[（11.4±3.6）×10¹²/L vs.（12.8±3.5）×10¹²/L，P=0.031]低于无发热组，后循环受累比例（35.2% vs. 11.5%，P=0.002）高于无发热组，另外，术后发热组出院预后不良率低于无发热组（4.4% vs. 15.4%，P=0.049）。logistic回归显示后循环受累的患者更易出现术后非感染性发热（OR 3.731，95%CI 1.265～10.998，P=0.017）。

结论 MMD患者在血运重建手术治疗后非感染性发热较常见，其中后循环受累的患者更易出现术后发热。

文章导读： 本研究通过回顾性队列分析发现MMD患者在脑血运重建术后出现非感染性发热的现象较为常见，且后循环受累的患者更易出现术后发热。

关键词: 烟雾病; 脑血运重建术; 围手术期; 发热; 危险因素

Abstract:

Objective To investigate the incidence and risk factors of postoperative non-infective fever (POF) after cerebral revascularization in moyamoya disease (MMD).

Methods This retrospective study enrolled the consecutive patients with MMD who received revascularization surgery at Beijing Neurosurgical Institute between November 2019 and February 2021. Clinical information were collected and analyzed. The poor prognosis at discharge was defined as a mRS score >2. POF was defined as postoperative temperature > 38℃ without systematic infection evidence within 14 days after surgery. A multivariate logistic regression analysis was conducted to determine the risk factors for POF.

Results A total of 110 patients including143 hemispheres were included in the final analysis. POFs occurred in 91 patients (63.6%), 81 (89.0%) of whom had a fever within 2 days after surgery. Univariable analysis showed the proportion of adults (74.7% vs. 88.5%, P=0.049) and males (37.4% vs. 63.5%, P=0.003) and poor prognosis at discharge (4.4% vs. 15.4%, P=0.049), and postoperative hematocrit [(33.6±4.2)% vs. (35.8±4.3)%, P=0.004], red blood cell counts [(3.9±0.5)×10¹²/L vs. (4.1±0.5)×10¹²/L, P=0.004)], and white blood cell counts [(11.4±3.6)×10¹²/L vs. (12.8±3.5)×10¹²/L, P=0.031)] were lower in patients with POF than those in patients without POF, while the proportion of posterior circulation involvement (35.2% vs. 11.5%, P=0.002) was higher in patients with POF than that in ones without POF. Logistic regression analysis showed that the patients with posterior circulation involvement were more likely to have POF (OR 3.731, 95%CI 1.265-10.998, P=0.017).

Conclusions POF was more common in MMD patients after cerebral revascularization, especially ones with posterior circulation involvement.

Key words: Moyamoya disease; Cerebral revascularization; Perioperative; Fever; Risk factor

康帅, 韩鹤泽, 鲁峻麟, 陈晓霖, 陈玉, 叶迅, 王嵘, 赵元立. 烟雾病血运重建术后非感染性发热的发病率与危险因素分析[J]. 中国卒中杂志, 2022, 17(07): 742-747.

KANG Shuai, HAN Heze, LU Junlin, CHEN Xiaolin, CHEN Yu, YE Xun, WANG Rong, ZHAO Yuanli. Incidence and Risk Factors of Non-infective Fever after Cerebral Revascularization in Moyamoya Disease[J]. Chinese Journal of Stroke, 2022, 17(07): 742-747.

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