载瘤动脉临时阻断处理颅内动脉瘤的临床研究  

A clinical study of temporary parent arterial occlusion in intracranial aneurysm surgery

作　　者：孙正辉[1] 许百男[1] 周定标[1] 余新光[1] 张远征[1] 姜金利[1] 卜博[1] 雪梅[1] 姜燕[1] 

机构地区：[1]中国人民解放军总医院神经外科,北京100853

出　　处：《中华神经外科杂志》2003年第5期361-363,共3页Chinese Journal of Neurosurgery

摘　　要：目的 探讨载瘤动脉临时阻断处理动脉瘤继发缺血性脑功能损伤的相关因素。方法63例颅内动脉瘤夹闭过程中行载瘤动脉临时阻断,术后根据相应部位有无脑功能障碍,CT检查阻断血管供应区有无新鲜梗塞灶为标准判断是否造成缺血性脑损伤,并按有无蛛网膜下腔出血、动脉瘤所在部位、Hunt和Hess分级等进行分组对照。结果 63例载瘤动脉临时阻断时间3～59min,术后共有12例出现缺血性脑损伤表现,其中术前有蛛网膜下腔出血(SAH)者11例,Hunt和Hess分级Ⅲ～Ⅴ者8例,基底动脉5例、大脑中动脉4例。阻断时间16min以内者均无缺血性脑损伤。结论 载瘤动脉临时阻断继发缺血性脑损伤与阻断部位、阻断时间、阻断方式、侧支循环的个体差异、病人术前状况等因素有关。Objective To identify the related factors associated with cerebral introgenic ischemia after temporary parent arterial occlusion (TAO) in intracranial aneurysm surgery. Method 63 patients with intracranial aneurysm underwent TAO during aneurym clipping. After operation, The postoperative cerebral ischemia was determined by the CT scanning in which the newly developed low-density area was found or by the clinical neurological deficit. Statistical analysis according to pre -operative SAH, aneurysm site, and Hunt and Hess grading was made. Result The intervals of TAO in all cases were 3 to 59 min. Among 12 patients demonstrated evidence of cerebral ischemia, 11 had preo-perative SAH,8 had poor pre-operative clinical Hunt & Hess grade (grades III - V) ,5 had basilar artery aneurysms and 4 had middle cerebral artery aneurysms. No patient presented cerebral ischemia if the interval of TAO was less than 16 minutes. Conclusion The related factors associated with cerebral iatrogenic ischemia after temporary arterial occlusion (TAO) in intracranial aneurysm surgery include the duration of TAO , the different artery occluded, the use of continue or intermittent occlusion, the individiul diference of lateral branch circulation and preoperative clinical grading of the patient.

关 键 词：颅内动脉瘤 载瘤动脉 临时阻断处理 临床研究 脑缺血 

分 类 号：R739.4[医药卫生—肿瘤]