前循环高级别破裂动脉瘤急诊开颅术中脑肿胀的对策  

Management of brain swelling in surgical treatment of high-level ruptured aneurysm in the pre-willing circle

作　　者：李劲松[1] 王汉东[1] 杭春华[1] 潘云曦[1] 刘翔宇[1] 彭岱[1] 

机构地区：[1]南京军区南京总医院神经外科,南京医学博士210002

出　　处：《医学研究生学报》2013年第11期1165-1167,共3页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81171170)

摘　　要：目的前循环高级别破裂动脉瘤手术中脑肿胀是影响手术效果的重要原因，文中探讨解决这一问题的方法。方法回顾性分析了2011年9月至2012年3月收治的5l例中高级别动脉瘤性蛛网膜下腔出血（aneurismalsubarachnoidhemorrhage，aSAH）病例，采用术中腰穿持续引流、脑室额角穿刺和清除血肿后再释放脑脊液3种方法以降低颅内压，利于显露、夹闭动脉瘤。结果动脉瘤全部夹闭，1个月后患者GOS评分：好（4—5分）25例（49．O％），差（2～3分）24例（47．1％），死亡（1分）2例（3．9％）。结论通过术中释放脑脊液的方法可取得良好的显露效果，顺利夹闭动脉瘤。Objective Brain swelling is an important factor that influences the operation effect of high-level ruptured aneu- rysm in the pre-willing circle. This paper discusses the methods to solve the problem. Methods We retrospectively analyzed 51 ca- ses of high-level aneurysmal subarachnoid hemorrhage （aSAH） surgically treated from September 2011 to March 2012. In operation, we used intraoperative continuous lumbar puncture drainage, frontal ventricle puncture and removal of hematoma to release cerebrospi- nal fluid, reduce intracranial pressure and make it easier to expose and clip the tumors. Results All the aneurysms were clipped successfully. At 1 month after surgery, the GOS scores were 4 -5 in 20 cases （43.4%）, 2 -3 in 24 cases （52.2%）, and 1 in 2 ca- ses of death （4.3%）. Condusion Intraoperative re/ease of cerebrospinal fluid can help to achieve good exposure and successful clipping of aneurysm.

关 键 词：动脉瘤 脑肿胀 手术 急诊 

分 类 号：R651.11[医药卫生—外科学]