Choi Eun-Su, Lee Yoon-Sook, Park Byeong-Seon, Kim Byung-Gun, Sohn Hye-Min, Jeon Young-Tae
Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Gyeonggi-do 15355, Korea.
Department of Anesthesiology and Pain Medicine, College of Medicine, Inha University Hospital, Incheon 22322, Korea.
J Clin Med. 2019 May 9;8(5):638. doi: 10.3390/jcm8050638.
Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is the most commonly used treatment for Moyamoya disease. During the perioperative period, however, these patients are vulnerable to ischemic injury or hyperperfusion syndrome. This study investigated the ability of combined remote ischemic pre-conditioning (RIPC) and remote ischemic post-conditioning (RIPostC) to reduce the occurrence of major neurologic complications in Moyamoya patients undergoing STA-MCA anastomosis. The 108 patients were randomly assigned to a RIPC with RIPostC group ( = 54) or a control group ( = 54). Patients in the RIPC with RIPostC group were treated with four cycles of 5-min ischemia and 5-min reperfusion before craniotomy and after STA-MCA anastomosis (RIPostC). The incidence of postoperative neurologic complications and the duration of hospital stay were determined. The overall incidence of neurologic complication was significantly higher in the control group than in the RIPC with RIPostC group (13 vs. 3, = 0.013). The duration of hospital stay was significantly longer in the control group than in the RIPC with RIPostC group (17.8 (11.3) vs. 13.8 (5.9) days, = 0.023). Combined remote ischemic pre- and post-conditioning can be effective in reducing neurologic complications and the duration of hospitalization in Moyamoya patients undergoing STA-MCA anastomosis.
颞浅动脉-大脑中动脉（STA-MCA）吻合术是烟雾病最常用的治疗方法。然而，在围手术期，这些患者易发生缺血性损伤或高灌注综合征。本研究调查了联合远程缺血预处理（RIPC）和远程缺血后处理（RIPostC）对减少接受STA-MCA吻合术的烟雾病患者发生主要神经并发症的能力。108例患者被随机分为RIPC联合RIPostC组（n = 54）或对照组（n = 54）。RIPC联合RIPostC组的患者在开颅手术前和STA-MCA吻合术后接受四个周期的5分钟缺血和5分钟再灌注治疗（RIPostC）。确定术后神经并发症的发生率和住院时间。对照组神经并发症的总发生率显著高于RIPC联合RIPostC组（13例 vs. 3例，P = 0.013）。对照组的住院时间显著长于RIPC联合RIPostC组（17.8（11.3）天 vs. 13.8（5.9）天，P = 0.023）。联合远程缺血预处理和后处理可有效减少接受STA-MCA吻合术的烟雾病患者的神经并发症和住院时间。
