个体化血压及液体管理对烟雾病脑血管重建术后过度灌注综合征的影响

doi:10.3969/j.issn.1673-5765.2022.12.011

摘要/Abstract

摘要： 目的研究烟雾病脑血管重建术后出现过度灌注综合征患者的血压及液体控制护理方案的效果。
方法前瞻性连续入组2019年9月-2022年1月在首都医科大学附属北京天坛医院行颅内外脑血管重建术后7 d内合并过度灌注综合征的成人烟雾病患者为研究对象，采用数字法将患者随机分为对照组和研究组。对照组进行常规护理，研究组在常规护理基础上进行动态血压调整、液体管理的个体化护理措施，使用mRS、Barthel指数和纽卡斯尔护理满意度量表（Newcastle satisfaction with nursing scale，NSNS）分别评价两组患者出院时神经功能预后和护理满意度，以mRS 0～1分为神经功能预后良好。
结果共入组112例患者，对照组和研究组各56例，两组的基线资料差异无统计学意义。出院时研究组神经功能预后良好比例优于对照组（48.2% vs. 26.8%，P=0.036）；研究组Barthel指数高于对照组（82.5±7.1分 vs. 78.2±9.5分，P=0.007）；研究组的护理满意度也高于对照组（96.4% vs. 83.9%，P=0.026）。
结论对烟雾病颅内外脑血管重建术后过度灌注患者实施个体化血压和液体管理可改善患者的神经功能预后，提高日常生活能力，且患者对护理的满意度较高。

文章导读： 本研究通过前瞻性研究设计，探索了个体化的血压和液体管理护理策略对改善烟雾病直接脑血管重建术后过度灌注综合征患者的短期神经功能结局和生活能力的效果，显示其是一种有临床推广价值的术后管理策略。

关键词: 烟雾病; 颅内外血管重建术; 高灌注; 并发症; 护理策略

Abstract: Objective To explore the effect of blood pressure and liquid control in moyamoya disease (MMD) patients with cerebral hyperperfusion syndrome after extracranial-intracranial (EC-IC) bypass.
Methods The MMD patients with hyperperfusion complication within 1 week after EC-IC bypass in Beijing Tiantan Hospital, Capital Medical University between September 2019 and January 2022 were prospectively enrolled in this study. Participants were randomly divided into control group and observation group. The control group received routine nursing care, while the observation group received individualized nursing with dynamic management of blood pressure and liquid control based on routine nursing. The mRS, Barthel index (BI), and Newcastle satisfaction with nursing scale (NSNS) were used to evaluate the functional prognosis and nursing satisfaction at discharge. The favorable prognosis was defined as a mRS score of 0-1.
Results A total of 112 eligible patients were included, with 56 cases in each group. There was no statistical difference in baseline data between the two groups. The percentage of favorable prognosis in observation group was higher than that in control group (48.2% vs. 26.8%, P=0.036). The BI in observation group at discharge was higher than that in control group (82.5±7.1 points vs. 78.2±9.5 points, P=0.007). Nursing satisfaction in observation group was higher than that in control group (96.4% vs. 83.9%, P=0.026).
Conclusions Individualized management of blood pressure and liquid control for MMD patients with hyperperfusion syndrome after direct revascularization can improve the patients’ functional prognosis, and enhance their activities of daily living.

Key words: Moyamoya disease; Extracranial-intracranial bypass; Hyperperfusion; Complication; Nursing strategy

桂金敏, 薛锐, 李娜, 刘青林, 赵东红. 个体化血压及液体管理对烟雾病脑血管重建术后过度灌注综合征的影响 [J]. 中国卒中杂志, 2022, 17(12): 1350-1354.

GUI Jinmin, XUE Rui, LI Na, LIU Qinglin, ZHAO Donghong. Individualized Management of Blood Pressure and Liquid Control for Moyamoya Patients with Hyperperfusion Syndrome after Extracranial-Intracranial Bypass[J]. Chinese Journal of Stroke, 2022, 17(12): 1350-1354.

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