大脑中动脉动脉瘤夹闭术后脑梗死的预防与治疗  

Prevention and treatment of cerebral infarction following middle cerebral artery aneurysm clipping

作　　者：邹钦[1] 阳小生[1] 邹云龙[1] 吴小兵[1] 阳文任[1] 

机构地区：[1]南华大学附属南华医院神经外科,衡阳421002

出　　处：《临床神经外科杂志》2015年第1期25-27,共3页Journal of Clinical Neurosurgery

摘　　要：目的探讨大脑中动脉动脉瘤夹闭术后脑梗死的发生原因、机制及其预防措施。方法回顾性分析27例经CT或MRI证实的大脑中动脉动脉瘤夹闭术后脑梗死患者的手术记录及术后的治疗,总结脑梗死的发生时间、发生年龄和发生部位。27例均经翼点入路,开放外侧裂池,充分显露载瘤动脉,解剖出动脉瘤颈部后进行夹闭。结果 27例大脑中动脉动脉瘤夹闭术后脑梗死患者发生的年龄偏高,15例出现在术后24 h内,17例位于基底节。随访0.5-2年,恢复良好16例,中残8例,植物生存1例,死亡2例。结论大脑中动脉动脉瘤夹闭术后脑梗死与术中机械性牵拉,血管临时阻断时间过长,阻断部位不当,动脉瘤夹的位置不当及术后血管痉挛引发的迟发性脑缺血有关。熟悉大脑中动脉的解剖,术中准确确定动脉瘤的位置,良好的显微手术技巧,术后采取积极预防措施可以明显降低脑梗死的发生率。Objective To explore the pathogenetic and prevention of cerebral infarction after middle cerebral artery aneurysm（MCAA） clipping.Methods The clinical data of 27 patients with cerebral infarction confirmed by CT scanning or MRI after the operation were analyzed retrospectively .The occurrence of infarction , the clinical manifestations and the prognosis of these patients were exprienced .All clipping surgery were performed under microscope via pterional approach .Results In 27 patients with cerebral infarction following middle cerebral artery aneurysm clipping, whose ages were elder , 15 of the 27 patients were delected within 24 h after surgery and 17 occuered in the region of basal ganglia .The follow up from 0.5 to 2 years showed 16 patients got good recovery, 8 moderately disabled, 1 in vegetative state and 2 died.Conclusions The occurrence of cerebral infarction after surgery for MCAA clipping is due to brain retraction ,long time for temporary clipping , the location of clipping the artery and clipps application , delayed cerebral perfusion pressure caused by cerebral vasospasm .Knowing the aspects of middle cerebral artery , good exposure and microsurgical techniques , vigorous preventive measures adopted after clipping , the postoperative incidence of the cerebral infarction may be significantly reduced .

关 键 词：大脑中动脉动脉瘤 夹闭术 脑梗死 预防 治疗 

分 类 号：R651.1[医药卫生—外科学]