DSA联合血清SICAM-1评估颅内破裂动脉瘤术后脑血管痉挛的效果  

Application of DSA combined with serum SICAM-1 to the evaluation of cerebral vasospasm after SAH due to aneurysmal rupture

作　　者：谢飞[1] 陈志远[1] 曾家良 叶勇强[1] 

机构地区：[1]资阳市第一人民医院神经外科,四川641300

出　　处：《中国临床神经外科杂志》2017年第9期617-618,622,共3页Chinese Journal of Clinical Neurosurgery

基　　金：四川省卫生厅科研课题(130505)

摘　　要：目的探讨DSA联合可溶性细胞间黏附分子-1(SICAM-1)评估颅内破裂动脉瘤术后脑血管痉挛(CVS)的效果。方法选择56例颅内破裂动脉瘤急诊术后病人作为研究对象,DSA测定脑血管直径判断CVS程度,结合Hunt-Hess分级,分析CVS与SICAM-1浓度关系。结果 56例中,30例无CVS,9例轻度CVS,10例中度CVS,7例重度CVS。重度CVS血清SICAM-1最高浓度出现在术后4~5 d,其余3组均出现在术后1~3 d。无CVS、轻度CVS、中度CVS与重度CVS血清SICAM-1浓度分别为(273.47±86.54)、(393.47±79.85)、(532.79±69.7)、(664.64±98.71)ng/ml,随着CVS加重,血清SICAM-1浓度显著增高(P<0.01)。结论脑动脉瘤破裂出血术后行DSA检查联合血清SICAM-1浓度监测可有效预示疾病进展,实现CVS动态观察,可作为CVS发作、进展的危险性评估指标。Objective To explore the feasibility of the application of DSA combined with serum soluble intercellular adhesionmolecule(SICAM-1) to the evaluation of cerebral vasospasm(CVS) severity after subarachnoid hemorrhage(SAH) caused by theaneurysmal rupture.MethodsThe diameters of the cerebral blood vessels including the first and second sections of the middle cerebralarteries and anterior cerebral arteries were determined by DSA in 56 patients with ruptured intracranial aneurysms undergoingemergency surgery. The severity of CVS was assessed by DSA outcomes combined with Hunt-Hess grading system. The serum levels ofSICAM-1 were determined in all the patients. The relationship of the severity of CVS with the serum levels of SICAM-1 was analyzed.ResultsOf 26 with postoperative CVS of 56 patients with ruptured aneurysms, 9 suffered from mild CVS, 10 from moderate and 7 severe.From 1 to 10 days after the surgery, the mean serum level of SICAM-1 [(664.64 ±98.71) ng/ml] was significantly higher in 7 patientswith severe CVS than that [(532.79±69.71) ng/ml] in 10 with moderate CVS(P<0.01), which was significantly higher than that [(393.47±79.51) ng/ml] in 9 with mild CVS(P<0.01), which was significantly higher than that [(273.47±86.54) ng/ml] in 30 without CVS(P<0.01).ConclusionThe serum level of SICAM-1 was positively related to the severity of CVS in the patients with SAH due to rupturedintracranial aneurysms undergoing the surgery. It is suggested that the serum level of SICAM-1 may serve as an index of CVS severity.

关 键 词：动脉瘤性蛛网膜下腔出血 脑血管痉挛 数字减影血管造影 可溶性细胞间黏附分子-1 

分 类 号：R743.9[医药卫生—神经病学与精神病学]