摘要： 目的 探讨烟雾病脑血管重建术后脑过度灌注综合征患者出现“新常春藤征”相关影响因素。方法 纳入北京航空总医院2019年1-12月收治的45例烟雾病患者，均行颞浅动脉-大脑中动脉搭桥术联合脑-硬脑膜-颞肌-动脉-骨膜瓣贴敷术且术后发生脑过度灌注综合征，记录术后“新常春藤征”出现率，单因素和多因素Logistic回归分析筛查术后出现“新常春藤征”的影响因素。结果 共45例患者，左侧手术后脑过度灌注综合征主要表现为语言障碍（96.43%，27/28）、右侧肢体感觉和运动障碍（21.43%，6/28），右侧手术后主要表现为左侧肢体感觉和运动障碍（9/17）、流涎和吞咽困难（3/17）。术后26例（57.78%）出现“新常春藤征”，分别位于大脑前动脉供血区（2例）、大脑中动脉供血区前部（9例）、大脑中动脉供血区后部（6例）、大脑前动脉供血区和大脑中动脉供血区前部（4例）、大脑中动脉供血区前部和后部（5例）。根据性别、年龄、病程、术前有无“常春藤征”、手术侧别、术后脑过度灌注综合征发生时间和恢复时间分层，术前无“常春藤征”、术后脑过度灌注综合征发生时间≤ 3 d和恢复时间≤ 7 d的患者术后“新常春藤征”出现率高于术前存在“常春藤征”（χ²=5.830，P=0.016）、术后脑过度灌注综合征发生时间> 3 d（χ²=30.162，P=0.000）和恢复时间> 7 d（χ²=6.764，P=0.009）患者；进一步行Logistic回归分析显示，仅术后脑过度灌注综合征发生时间≤ 3 d是术后出现“新长春藤征”的危险因素（OR=261.155，95% CI：7.635~8932.982；P=0.002）。结论 烟雾病脑血管重建术手术侧别不同，术后脑过度灌注综合征表现各异。“新常春藤征”是烟雾病脑血管重建术后短暂性血流动力学改变，术后3天内出现脑过度灌注综合征的患者易形成“新常春藤征”。

关键词: 脑底异常血管网病, 脑血管重建术, 血流动力学, 手术后并发症, 危险因素, Logistic模型

Abstract: Objective To investigate the related influencing factors of "de novo ivy sign" in patients with cerebral hyperperfusion syndrome (CHS) after moyamoya disease (MMD) surgery. Methods A total of 45 patients with MMD admitted to Aviation General Hospital from January to December 2019 were enrolled, all of whom underwent superficial temporal artery (STA) -middle cerebral artery (MCA) bypass and encephalo-duro -myo -arterio-pericranio-synangiosis (EDMAPS) and suffered from CHS after surgery. The occurrence rate of "de novo ivy sign" after surgery was recorded. Univariate and multivariate Logistic regression analyses were used to screen the influcencing factors for postoperative "de novo ivy sign". Results In a total of 45 patients, the main manifestations of CHS after left surgery were language disorders in 27 cases (96.43%, 27/28), right limb sensory and motor disorders in 6 cases (21.43%, 6/28), and left limb sensory and motor disorders after right surgery in 9 cases (9/17), salivation and swallowing difficulties in 3 cases (3/17). A total of 26 patients (57.78%) developed "de novo ivy sign" after surgery, which were located in the anterior cerebral artery (ACA) blood supply area (2 cases), the anterior MCA blood supply area (9 cases), the posterior MCA blood supply area (6 cases), the ACA blood supply area and the anterior MCA blood supply area (4 cases), and the anterior and posterior MCA blood supply area (5 cases). The probability of the occurrence of "de novo ivy sign" in the patients without "ivy sign" before surgery, the occurrence time of postoperative CHS ≤ 3 d and the recovery time ≤ 7 d after surgery was higher than that of the patients with "ivy sign" before surgery (χ²=5.830, P=0.016), the occurrence time of postoperative CHS > 3 d (χ²=30.162, P=0.000), and recovery time > 7 d (χ²=6.764, P=0.009). Logistic regression analysis showed only the occurrence time of postoperative CHS ≤ 3 d was a risk factor for postoperative "de novo ivy sign" (OR=261.155, 95%CI:7.635 -8932.982; P=0.002). Conclusions The manifestations of CHS after MMD were different in the surgical side. "De novo ivy sign" is a transient hemodynamic change after cerebrovascular reconstruction of MMD, and it is easy to form "de novo ivy sign" in patients who develop CHS within 3 d after surgery.

Key words: Moyamoya disease, Cerebral revascularization, Hemodynamics, Postoperative complications, Risk factors, Logistic models