颅内动脉瘤介入治疗围术期处理的研究  

Perioperative Management of Intravascular Embolization for Cerebral Aneurysm

作　　者：傅军[1] 李选[1] 韩金涛[1] 王昌明[1] 栾景源[1] 吕献军[1] 李天润[1] 曲雯[1] 冯琦琛[1] 庄金满[1] 马晓娟[1] 隋玉洁[1] 

机构地区：[1]北京大学第三医院介入血管外科,北京100191

出　　处：《中国微创外科杂志》2015年第2期97-100,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨颅内动脉瘤栓塞治疗的围手术期处理措施。方法 2002年12月~2013年5月对210例颅内动脉瘤行弹簧圈栓塞,围手术期行脱水、解痉、脑复苏、控制输液、抗血小板等治疗。结果 195例急性蛛网膜下腔出血和脑出血行全脑血管造影发现颅内动脉瘤并行急诊栓塞治疗（1例首次造影未发现动脉瘤,2 d后再次造影发现动脉瘤并成功栓塞）。围手术期死亡8例,致伤残4例,3例入院时昏迷,出院时基本恢复正常。190例平均随访43.5月（6~116个月）,其中〉36个月130例,〉60个月90例：12例术后6~12个月复查发现新发及栓塞处动脉瘤扩大,行再次栓塞,复发率6.3%（12/190）;GOS平均4.6分（4~5分）;格拉斯哥昏迷评分（GCS）均为15分,术前平均13分（5~15分）。结论对于蛛网膜下腔出血者,应尽快行全脑血管造影术,可明确颅内动脉瘤的诊断和栓塞治疗;加强围术期的各种管理,如脱水、腰穿、抗痉挛、抗血小板治疗等措施可以加快患者康复并减少各种并发症的发生。Objective To explore perioperative management of intravascular embolization therapy for cerebral aneurysm.Methods From December 2002 to May 2013,210 cases of intracranial aneurysm underwent intravascular embolization therapy. The measures of comprehensive perioperative management included dehydration,antispasmodic,cerebral resuscitation,fluid resuscitation,antiplatelet,and so on. Results A total of 195 patients with subarachnoid or cerebral hemorrhage underwent cerebral angiography and intravascular embolization for cerebral aneurysm（ in 1 patient with negative findings of initial angiography,a re-examination was given 2 days later and aneurysm was confirmed and successfully embolized）. Eight patients died after the operation,and 4 patients suffered from complications and were disabled. Three patients with coma when admitted were fully recovered after the therapy. Followup reviews for 6- 116 months（ mean,43. 5 months） were conducted in 190 cases,including 36 months in 130 cases and 60 months in 90 cases. Postoperative re-examinations found newly emerging or relapse of aneurysm in 12 cases at 6- 12 months after operation,which were given a second intravascular embolization,the recurrence rate being 6. 3%（ 12 /190）. The GOS was 4- 5points（ mean,4. 6 points）,and the mean GCS was 13 points（ 5- 15 points） preoperatively and 15 points postoperatively.Conclusions Cerebral angiography should be actively undertaken for subarachnoid hemorrhage,which is essential for the diagnosis and embolization treatment of cerebral aneurysm. Perioperative management,such as dehydration,lumber puncture,anti-spasm,and anti-platelet,speeds the patients＇ recovery and reduces the complications.

关 键 词：蛛网膜下腔出血 脑血管造影术 动脉瘤栓塞 围术期 

分 类 号：R743[医药卫生—神经病学与精神病学]