颅内动脉瘤术后大脑半球肿胀的处理  

Management of global cerebral swelling following cerebral aneurysm surgery

作　　者：黄志坚[1] 漆凌骏 徐睿[1] 郭宗铎[1] 张晓冬[1] 何朝晖[1] 朱继[1] 孙晓川[1] Huang Zhifian,Qi Lingjun, Xu Rui, Guo Zongduo, Zhang Xiaodong, He Zhaohui, Zhu Ji, Sun Xiaochuan.(Department of Nenrosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China)

机构地区：[1]重庆医科大学附属第一医院,神经外科400010

出　　处：《中华神经外科杂志》2018年第10期988-992,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金（81571159）;国家临床重点专科建设经费[（2011）170]

摘　　要：目的探讨颅内动脉瘤术后大脑半球肿胀与脑血流过度灌注现象的处理。方法回顺性纳入2011年10月至2017年10月重庆医科大学附属第一医院神经外科收治的30例颅内动脉瘤术后大脑半球肿胀的患者。分析患者的临床资料、治疗方案和术后血流动力学变化及随访结果。结果停用解痉药物并且加强脱水治疗后，30例患者的平均格拉斯哥昏迷评分为（13．7±1．5）分，与啮肿胀时的（9．0±1．2）分相比，差异有统计学意义（P〈0．01）。与术前相比，大脑半球肿胀时的脑血流萤增高了4．72（7．28）ml·100g-1·min-；脑血容量增高了0．36（0．74）ml／10（3g；平均通过时间延长了2．52（2．34）s；大脑中动脉的最大流速增快了50．35（66．99）crn／s，平均流速增快了26．43（46．19）（H]I／S，差异均有统汁学意义（均P〈0．01）。出院时的格拉斯哥预后评级V级22例，Ⅳ级4例，Ⅲ级4例。结论颅内动脉瘤术后的脑血流过度灌注可引起大脑半球肿胀，需与脑血管痉挛相鉴别。停用解痉药物并加强脱水治疗能明显减轻脑肿胀，改善患者的神经功能障碍。Objective To explore the management of global eerebral swelling and hyperperfusion in patients following cerebral aneurysm surgery. Methods A retrospective study was conducted on 30 patients who developed global cerebral edema post operation of intracranial aneurysm and admitted to Department of Neurnsurgery, the First Affiliated Hospital of Chongqing Medical University from October 2011 to October 2017. The patients＇ medical records, laboratory data and outcome follow-up results were analyzed. Results The GCS（ Glasgow coma seole） scores were significantly increased from 9. 0 ± 1.2 to 13.7 ± 1.5 ＇after the treatment of withdrawal of antti-vasospasm drugs combined with dehydration therapy （ P 〈 0.01 ）. During global cerebral edema, the global cerebral blood flow （CBF） increased 4. 72 （7.28） mI · 100 -1g ·min -1 , the global cerebral blood volume （CBV） increased 0. 36 （0. 74） ml/100 g, the mean transit time （MTF） increased 2.52 （2. 34 ） s, the maximum velocity of MCA （Vmax） increased 50. 35 （66.99）cm/s, the mean velocity of MCA （Vmean） increased 26. 43 （46. 19）cm/s compared with pre-surgical data （all P 〈 0. 01 ）. For outcome assessment, GOS grade V was reported in 22 cases, IV in 4 and III in 4 at discharge. Conclusions Cetebrovaseular hyperperfusion leads to global cerebral swelling following intracranial aneurysm surgery, which needs to be differentiated from cerebral vasospasm. Withdrawal of anti-vasospasm drugs combined with dehydration therapy could alleviate global cerebral edema and improve the patient＇s neurological deficits.

关 键 词：颅内动脉瘤 神经外科手术 脑水肿 血流动力学 治疗结果 

分 类 号：R651.12[医药卫生—外科学]