Individualized Management of Blood Pressure and Liquid Control for Moyamoya Patients with Hyperperfusion Syndrome after Extracranial-Intracranial Bypass

doi:10.3969/j.issn.1673-5765.2022.12.011

Abstract

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

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。

关键词: 烟雾病; 颅内外血管重建术; 高灌注; 并发症; 护理策略

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.

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.

References

[1] KURODA S，KAMIYAMA H，ABE H，et al. Cerebral blood flow in children with spontaneous occlusion of the circle of Willis（moyamoya disease）：comparison with healthy children and evaluation of annual changes[J]. Neurol Med Chir（Tokyo），1993，33（7）：434-438.
[2] KUWABARA Y，ICHIYA Y，OTSUKA M，et al. Cerebral hemodynamic change in the child and the adult with moyamoya disease[J]. Stroke，1990，21（2）：272-277.
[3] Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis，Health Labour Sciences Research Grant for Research on Measures for Infractable Diseases. Guidelines for diagnosis and treatment of moyamoya disease（spontaneous occlusion of the circle of Willis）[J]. Neurol Med Chir（Tokyo），2012，52（5）：245-266.
[4] 赵东红，陈虹岩，薛锐，等. 个体化的心理护理措施在成人烟雾病患者脑血运重建手术中的应用[J]. 中国医药导报，2022，19（24）：147-150，162.
[5] KAZUMATA K，UCHINO H，TOKAIRIN K，et al. Cerebral hyperperfusion syndrome after revascularization surgery in moyamoya disease：region-symptom mapping and estimating a critical threshold[J/OL]. World Neurosurg，2018，114：e388-e395[2022-04-10]. https://doi.org/10.1016/j.wneu.2018.02.190.
[6] 袁萍，徐博，陈璐. 精准血压管理预防烟雾病术后患者脑过度灌注综合征[J]. 护理学杂志，2021，36（11）：25-27.
[7] ZHANG J J，LI S R，FUJIMURA M，et al. Hemodynamic analysis of the recipient parasylvian cortical arteries for predicting postoperative hyperperfusion during STA-MCA bypass in adult patients with moyamoya disease[J]. J Neurosurg，2019，134（1）：17-24.
[8] MODOLO R，DE FARIA A P，ALMEIDA A，et al. Resistant or refractory hypertension：are they different?[J]. Curr Hypertens Rep，2014，16（10）：485.
[9] GE P C，ZHANG Q，YE X，et al. Long-term outcome after conservative treatment and direct bypass surgery of moyamoya disease at late suzuki stage[J/OL]. World Neurosurg，2017，103：283-290[2022-04-10]. https://doi.org/10.1016/j.wneu.2017.03.101.
[10] KAZUMATA K，THA K K，TOKAIRIN K，et al. Brain structure，connectivity，and cognitive changes following revascularization surgery in adult moyamoya disease[J/OL]. Neurosurgery，2019，85（5）：e943-e952[2022-04-10]. https://doi.org/10.1093/neuros/nyz176.
[11] SHI Z Y，WEN Y J，HUANG Z，et al. Different aspects of cognitive function in adult patients with moyamoya disease and its clinical subtypes[J]. Stroke Vasc Neurol，2020，5（1）：86-96.
[12] NAKAMIZO A，AMANO T，MICHIWAKI Y，et al. Long-term neurocognitive outcomes in patients with adult moyamoya disease[J/OL]. World Neurosurg，2018，119：e441-e448[2022-04-10]. https://doi.org/10.1016/j.wneu.2018.07.179.
[13] 吴永钧，钟维章. 脑高灌注综合征的发生与预防[J]. 疑难病杂志，2014，13（2）：215-217.
[14] 姚东陂，缪中荣. 颈动脉支架置入术后脑高灌注综合征的临床研究现状及进展[J/OL]. 中华脑血管病杂志（电子版），2020，14（3）：129-132[2022-04-10]. https://zhnxgbzz.cma-cmc.com.cn/CN/10.11817/j.issn.1673-9248.2020.03.002. DOI：10.11817/j.issn.1673-9248.2020.03.002.
[15] 赵东红，李晶. 术前液体治疗对成人烟雾病患者麻醉诱导后血压波动的效果分析[J]. 中国脑血管病杂志，2022，19（4）：264-270，277.
[16] 马丁，石志勇，张东. 基于铃木分期的成人烟雾病认知功能初步研究[J]. 中华神经外科杂志，2020，36（7）：671-676.
[17] 赵东红，张东，薛锐，等. 个性化脑认知功能护理与训练在成人烟雾病手术患者中的应用研究[J]. 中国卒中杂志，2021，16（11）：1144-1149.