Sato K, Shirane R, Yoshimoto T
Department of Anesthesiology, Tohoku University School of Medicine, Sendai, Japan.
Childs Nerv Syst. 1997 Feb;13(2):68-72. doi: 10.1007/s003810050044.
In purpose of clarifying the risk factors of perioperative ischemic complications in cases with moyamoya disease, a retrospective study was conducted on the perioperative care of 36 patients who underwent vascular reconstruction for moyamoya disease. Following surgery, 8 patients developed ischemic complications (5 with minor completed strokes and 3 with transient ischemic attacks). Three factors including the presence of a preoperative low density area (LDA), intra-operative urinary output, and a reduction in the hematocrit significantly differed with complications and those without. In an evaluation of individual cases, intra-operative hypercapnia, hypotension, and a reduction in the circulating blood volume also were identified as potential factors associated with complications. On the basis of these findings, it was concluded that it is necessary to infuse an adequate amount of fluids, maintain normocapnic and normothermic states, and actively correct anemia in patients undergoing vascular reconstruction for moyamoya disease. It is also necessary to pay particular attention to perioperative care in patients in whom a LDA is detected by preoperative CT.
为了阐明烟雾病患者围手术期缺血性并发症的危险因素，对36例行烟雾病血管重建术患者的围手术期护理进行了一项回顾性研究。术后，8例患者出现缺血性并发症（5例为轻度完全性卒中，3例为短暂性脑缺血发作）。术前低密度区（LDA）的存在、术中尿量和血细胞比容降低这三个因素在有并发症和无并发症的患者中存在显著差异。在对个别病例的评估中，术中高碳酸血症、低血压和循环血容量减少也被确定为与并发症相关的潜在因素。基于这些发现，得出结论，对于行烟雾病血管重建术的患者，有必要输注足够量的液体，维持正常碳酸血症和正常体温状态，并积极纠正贫血。对于术前CT检测到LDA的患者，围手术期护理也需要特别关注。
