显微夹闭术与介入栓塞术对颅内动脉瘤患者术中脑氧代谢及预后的影响  

Effect of microsurgical clipping and interventional embolization on intraoperative cerebral oxygen metabolism and prognosis in patients with intracranial aneurysm

作　　者：宁彧 蔡宏伟[2] NING Yu;CAI Hong-Wei(The First Hospital of Hunan University of Chinese Medicine,Changshang,Hunan 410021,China;XiangYa Hospital Central South University,Changshang,Hunan 410008,China)

机构地区：[1]湖南中医药大学第一附属医院麻醉科,湖南长沙410021 [2]中南大学湘雅医院麻醉科,湖南长沙410008

出　　处：《国际神经病学神经外科学杂志》2022年第6期23-28,共6页Journal of International Neurology and Neurosurgery

基　　金：湖南省自然科学基金(2021JJ30529)。

摘　　要：目的对比研究颅内动脉瘤显微夹闭术与介入栓塞术对颅内动脉瘤患者围术期脑氧代谢的影响以及对患者短期预后的影响。方法择期手术颅内动脉瘤患者36例,根据不同手术方式分为动脉瘤显微夹闭组(A组)与介入动脉瘤栓塞组(B组),各18例。经颈内静脉逆行置管后,分别于麻醉置管后即刻(T1)、动脉瘤处理前(T2)、动脉瘤处理后即刻(T3)及术毕(T4)4个时间点采取外周动脉血和横窦静脉血做血气分析,监测并比较两组脑氧代谢结果,比较两组患者预后情况。结果B组内与T1比较,T4的横窦静脉血氧饱和度(SsvO_(2))明显下降,动脉血乳酸浓度(aLAC)明显升高,差异具有统计学意义(P<0.05)。与A组比较,B组T2所对应的动静脉氧含量差(Da-svO_(2))、脑氧摄取率(CERO_(2))增加,术后是否入重症监护室(ICU)、术后住院时间以及相关有创操作明显减少,差异具有统计学意义(P<0.05)。两组出院6个月内的改良RANKIN量表(mRS评分)比较,差异具有统计学意义(P<0.05),B组明显优于A组。结论与显微夹闭术治疗颅内动脉瘤比较,介入栓塞术中对脑氧供需平衡影响较大,但患者短期预后较好。Objective To compare the effect of microsurgical clipping and interventional embolization on perioperative cerebral oxygen metabolism and short-term prognosis in patients with intracranial aneurysm.Methods Thirty-six patients with intracranial aneurysm scheduled for selective operation were divided into group A(microsurgical clipping treatment,18 patients)and group B(interventional embolization treatment,18 patients)according to different operation methods.After retrograde catheterization through the internal jugular vein,peripheral arterial blood and transverse sinus venous blood were taken at four time points for blood gas analysis:immediately after anesthesia catheterization(T1),before aneurysm treatment(T2),immediately after aneurysm treatment(T3),and after operation(T4).The cerebral oxygen metabolism indicators and prognosis were monitored and compared between the two groups.Results Compared with T1 within group B,the transverse sinus venous oxygen saturation at T4 was decreased significantly,and the arterial lactic acid concentration was increased significantly(P<0.05).Compared with group A,the corresponding arteriovenous oxygen content difference and cerebral oxygen extraction rate at T2 in group B were increased significantly,and the postoperative admission to intensive care unit,postoperative hospital stay,and related invasive procedures were significantly reduced(P<0.05).The modified Rankin scale score of group B was significantly better than that of group A within 6 months after discharge(P<0.05).Conclusions Compared with microsurgical clipping for intracranial aneurysm,interventional embolization has a significant influence on the balance of cerebral oxygen supply and demand during the operation,but brings patients better shortterm prognosis.

关 键 词：颅内动脉瘤 显微夹闭 介入栓塞 颈内静脉逆行置管 脑氧代谢 

分 类 号：R651.12[医药卫生—外科学]