摘要： 目的 分析缺血型烟雾病患者术前相对血糖比值与脑血管搭桥术安全性之间的关系。方法 以2016年12月至2019年12月在山东大学齐鲁医院神经外科住院治疗的178例缺血型烟雾病患者为观察对象，共行186例次颞浅动脉-大脑中动脉搭桥术。收集患者入院时空腹血糖和糖化血清白蛋白数据、计算相对血糖比值，记录术后并发症发生率；单因素与多因素Logistic回归分析筛查术后并发症危险因素。结果 术后并发症发生率为28.49%（53/186），其中，重型占8.60%（16/186），均为症状性脑梗死；轻型占19.89%（37/186），其中短暂性神经功能障碍97.30%（36/37）、硬膜下出血2.70%（1/37）。Logistic回归分析显示，高血压（OR=3.696，95% CI：1.805~7.569；P=0.000）、手术间隔< 2个月（OR=2.186，95% CI：1.041~4.590；P=0.039）、相对血糖比值升高（OR=1.484，95% CI：1.071~2.058；P=0.018）是术后并发症的危险因素。结论 烟雾病患者急性缺血性发作后脑血管搭桥术时间可延长至2个月后，同时关注术前相对血糖比值、严格控制围手术期血压，以降低术后并发症发生风险。

关键词: 脑底异常血管网病, 卒中, 脑缺血, 血糖, 脑血管重建术, 手术后并发症, Logistic模型

Abstract: Objective To analyze the relationship between the preoperative relative blood glucose ratio and the safety of cerebrovascular bypass of ischemic moyamoya disease (MMD) patients. Methods A total of 178 patients with ischemic MMD who were hospitalized in Department of Neurosurgery of Qilu Hospital of Shandong University from December 2016 to December 2019. A total of 186 cases underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass. The fasting blood glucose and glycated albumin of all patients at admission were recorded to calculate the relative blood glucose ratio. After STA-MCA bypass, the incidence of postoperative complications was counted. Univariate and multivariate Logistic regression were used to analyze the risk factors of postoperative complications of ischemic MMD. Results 186 cases were divided into 4 groups based on relative blood glucose ratio, Q1 < 0.404, Q2 0.404-, Q3 0.456-, Q4 ≥ 0.534. The proportion of right surgery side in Q1 group was higher than that in Q3 group (χ²=4.762, P=0.029) and Q4 group (χ²=22.087, P=0.000), while the proportion of right surgery side in Q2 group (χ²=16.331, P=0.000) and Q3 group (χ²=7.355, P=0.007) was higher than that in Q4 group. The incidence of mild complications in Q1 group (χ²=6.389, P=0.011) and Q2 group (χ²=4.040, P=0.044) was higher than that in Q4 group. The incidence of postoperative complications was 28.49% (53/186), of which 8.60% (16/186) were severe type and 19.89% (37/186) were mild type, including transient neurological dysfunction 97.30% (36/37), subdural hemorrhage 2.70% (1/37). Logistic regression analysis showed that the relative blood glucose ratio increased (OR=1.484, 95%CI:1.071-2.058; P=0.018), hypertension (OR=3.696, 95%CI:1.805-7.569; P=0.000), operative interval < 2 months (OR=2.186, 95%CI:1.041-4.590; P=0.039) was risk factors for postoperative complications. Conclusions In order to reduce the incidence of postoperative complications in patients with ischemic MMD, the operation interval after infarction can be extended to 2 months, and the preoperative relative blood glucose ratio should be closely monitored and the perioperative blood pressure should be controlled.

Key words: Moyamoya disease, Stroke, Brain ischemia, Blood glucose, Cerebral revascularization, Postoperative complications, Logistic models