颅内动脉瘤术后脑血管痉挛发生的相关因素分析  

Analysis on the related factors to vasospasm after intracranial aneurysm operation

作　　者：张良文[1] 朱树干[1] 见文成[1] 刘玉光[1] 李刚[1] 吴承远[1] 

机构地区：[1]山东大学齐鲁医院神经外科,济南250012

出　　处：《临床神经外科杂志》2004年第2期69-71,共3页Journal of Clinical Neurosurgery

摘　　要：目的探讨颅内动脉瘤术后脑血管痉挛发生的相关因素。方法对30例颅内动脉瘤患者采用经颅多普勒检查诊断脑血管痉挛。结合蛛网膜下腔出血(SAH)Fisher分级、手术时机、术前SAH次数、动脉瘤术中有无破裂等资料进行相关分析。结果蛛网膜下腔积血Fisher分级>Ⅱ级者术后脑血管痉挛发生率(86.7%)明显高于Ⅱ级及以下者(26.7%),P<0.01。Fisher分级与脑血管痉挛的发生明显相关(r=0.3164,P=0.0135);SAH后3周内手术脑血管痉挛发生率(75%)明显高于3周以后手术(20%),P<0.001。术前发生SAH2次以上患者的脑血管痉挛发生率(76.9%)明显高于1次(41.2%),P<0.001。动脉瘤术中有无破裂对脑血管痉挛发生无明显影响。结论(1)动脉瘤术后脑血管痉挛可能是SAH后脑血管痉挛病理过程的延续。(2)SAH后3周内手术是颅内动脉瘤术后脑血管痉挛发生的独立危险因素。(3)早期手术不能降低术后脑血管痉挛的发生率。Objective To explore the related factors to cerebral vasospasm after intracranial aneurysm operation. Methods 30 cases with intracranial aneurysm were diagnosed vasospasm by transcranial Dopple (TCD) . Clinical materials including Fisher Scale of the subarachnoid hemorrhage (SAH),opportunities of operation, times of SAH before operation, and aneurysm rupture in operation were analysed. Rusults The vasospasm incidence of Fisher Scale above Ⅱ group(86. 7% ) was significantly higher than the below Ⅱ group(26.7% )( P < 0.01) . Fisher Scale was related to the incidence of vasospasm ( r = 0.3164, P = 0.0135). The vasospasm incidence of operation in three weeks after SAH group (75% ) was significantly higher than the three weeks later group (20 % ) ( P < 0.001 ) . The vasospasm incidence of the group ( 76 .9 % ) with more than 2 times SAH before operation was higher than one times group(41 .2% ) ( P < 0.001) .There's no significant affection of aneurysm rupture in operation on the incidence of vasospasm. Conclusion (1) Postoperative cerebral vasospasm may be the prolonged pathology process of vasospasm after SAH. (2) Operation in three weeks after SAH is the independently risk factor on vasospasm. (3) Early period operation can not decrease the incidence of postoperative vasospasm.

关 键 词：颅内动脉瘤 蛛网膜下腔出血 脑血管痉挛 

分 类 号：R743.35[医药卫生—神经病学与精神病学]