ABSTRACT
Objective: To analyze the safety and efficacy of regular aspirin use after combined cerebral revascularization in patients with ischemic moyamoya disease. Methods: From December 2020 to October 2021, a total of 326 patients diagnosed with ischemic moyamoya disease by global cerebral angiography and undergoing first-time combined cerebral revascularization at the Moyamoya Disease Diagnosis and Treatment Research Center of our hospital were selected. Combined cerebral revascularization: superficial temporal artery-middle cerebral artery (STA-MCA) +encephalo-duro-myo-synangiosis (EDMS).Patients were screened by 2 senior physicians according to established inclusion/exclusion criteria. Patients were divided into aspirin and non-aspirin groups based on whether they received regular oral aspirin after surgery. A total of 133 patients were enrolled in the aspirin group. A total of 71 patients (204 cases) were enrolled in the non-aspirin group. Related data were collected before and 1 year after surgery and statistically analyzed to assess the prognosis of both groups. Results: In the two groups, the mRS Score was significantly different after one year (P = 0.023). TIA occurred in 26 patients (19.5%) in the aspirin group and 27 patients (38.0%) in the non-aspirin group within one year after surgery, and the difference between the two groups was statistically significant (P = 0.004). There was no significant difference in cerebral perfusion stage, the improvement rate of cerebral perfusion, Matsushima grading, bypass patency, and other complications within one year after the operation (P > 0.05). Conclusions: In patients with ischemic moyamoya disease who underwent combined cerebral revascularization, postoperative administration of aspirin can reduce the incidence of TIA without increasing the risk of bleeding, but it can not significantly improve the cerebral perfusion of the operation side, Matsushima grading, and bypass patency.
ABSTRACT
OBJECTIVE: To investigate the incidence and risk factors of postoperative respiratory complications (PRCs) in children with early-onset scoliosis (EOS) following posterior spine deformity surgery (PSDS) based on growth-friendly techniques, so as to help improve the safety of surgery. METHODS: A retrospective study of children with EOS admitted for PSDS based on growth-friendly techniques from October 2013 to October 2018 was reviewed at a single center. There were 73 children (30 boys, 43 girls) who fulfilled the criteria in this research. The mean age of the patients was 7 ± 6.2 years. Patients were divided into the groups with and without PRCs. Variables that might affect the PRCs during the perioperative period, including general factors, radiographic factors, laboratory factors and surgical factors, were analyzed using univariate analysis to evaluate the potential risk factors. The variables that were significantly different were further analyzed by binary logistic regression analysis to identify the independent factors of PRCs. RESULTS: All the 73 children included 42 idiopathic scoliosis (57.5%), 12 congenital scoliosis (16.4%), 10 syndromic scoliosis (13.7%) and nine neuromuscular scoliosis (12.3%). PRCs were detected in 16 children (21.9%) with nine different PRCs. The total frequency of detected PRCs was 54, including pleural effusion (25.9%), postoperative pneumonia (20.4%), hypoxemia (18.5%), atelectasis (14.8%), prolonged intubation with mechanical positive pressure ventilatory support (PIMPPVS) (7.4%), bronchospasm (3.7%), reintubation (3.7%), delayed extubation (3.7%) and pneumothorax (1.9%). Results of univariate testing demonstrated that the following six variables were statistically different (P < 0.05): nonidiopathic scoliosis, combined with pulmonary comorbidities, pretransferrin < 200 mg/dL, prealbumin < 3.5 g/dL, anesthesia time ≥ 300 min and blood loss to total blood volume ratio (BL/TBV) ≥ 15%. Binary logistic regression analysis confirmed that BL/TBV≥15% (odd ratio OR = 29.188, P = 0.010), combined with pulmonary comorbidities (OR = 19.216, P = 0.012), pretransferrin < 200 mg/dL (OR = 11.503, p = 0.024), and nonidiopathic scoliosis (OR = 7.632, P = 0.046) were positively linear correlated with PRCs in children with EOS following PSDS. CONCLUSION: PRCs has a higher incidence in children with EOS following PSDS. BL/TBV ≥15%, combined with pulmonary comorbidities, pre-transferrin < 200 mg/dL, and nonidiopathic scoliosis play an important role for the development of PRCs in this population.