CAJ | 학술논문

目的：评价术中微血管超声多普勒（IMD）在开颅动脉瘤夹闭术中的作用和 IMD对动脉瘤夹闭术患者的疗效。方法79例动脉瘤夹闭术患者术中于夹闭前、后采用 IMD探测动脉瘤囊、分支血管及载瘤动脉的血流速度；并对比分析 IMD对开颅动脉瘤夹闭术患者的疗效影响。结果 IMD发现大脑前动脉（ACA）、前交通动脉（ACoA）、大脑中动脉（MCA）动脉瘤患者以及复杂、巨大动脉瘤患者术中易出现因误夹或夹闭不全致载瘤动脉及分支血管血流速度改变而调整动脉瘤夹，另外术前 Hunt-Hess分级越高的患者越容易出现误夹或夹闭不全；常规应用术中 IMD探测的患者术后在住院日、再手术率、术后格拉斯哥昏迷（GOS）评分、并发症出现率等方面明显优于未行术中 IMD探测的患者。结论开颅动脉瘤夹闭术中常规应用 IMD有利于发现术中误夹或者夹闭不全，有利于及时调整动脉瘤夹位置，IMD辅助下的手术能明显改善患者术后 GOS评分、缩短住院日、降低再手术率及并发症出现的概率。
목적：평개술중미혈관초성다보륵（IMD）재개로동맥류협폐술중적작용화 IMD대동맥류협폐술환자적료효。방법79례동맥류협폐술환자술중우협폐전、후채용 IMD탐측동맥류낭、분지혈관급재류동맥적혈류속도；병대비분석 IMD대개로동맥류협폐술환자적료효영향。결과 IMD발현대뇌전동맥（ACA）、전교통동맥（ACoA）、대뇌중동맥（MCA）동맥류환자이급복잡、거대동맥류환자술중역출현인오협혹협폐불전치재류동맥급분지혈관혈류속도개변이조정동맥류협，령외술전 Hunt-Hess분급월고적환자월용역출현오협혹협폐불전；상규응용술중 IMD탐측적환자술후재주원일、재수술솔、술후격랍사가혼미（GOS）평분、병발증출현솔등방면명현우우미행술중 IMD탐측적환자。결론개로동맥류협폐술중상규응용 IMD유리우발현술중오협혹자협폐불전，유리우급시조정동맥류협위치，IMD보조하적수술능명현개선환자술후 GOS평분、축단주원일、강저재수술솔급병발증출현적개솔。
Objective To evaluate the role and effect of intraoperative microvascular Doppler ultrasonography(IMD)in the in-tracranial aneurysm clipping operation.Methods The blood flow velocities of aneurysmal sac,adjacent vessels and parental arteries were determined by IMD before and after clipping in 79 cases of intracranial aneurysm clippings;the influence of IMD on the effect of craniotomy for intracranial aneurysm clipping was comparatively analyzed.Results IMD demonstrated that the clip adj ustment was more likely to happen in the patients with anterior intracranial artery(ACA),anterior communication artery(ACoA)and middle intracranial artery(MCA)aneurysms,and the patients with complex,giant aneurysm due to the change of blood flow velocity in ad-jacent vessels and parental arteries caused by inadvertent occlusion or incomplete closure.In addition,the higher the preoperative Hunt-Hess classification,the easier the inadvertent occlusion or incomplete closur;the patients with conventional use of intraopera-tive IMD were significantly superior to those without intraoperative IMD in the aspects of the postoperative hospital stay,reopera-tion rate,postoperative GOS and complication occurence rate.Conclusion The routing use of IMD in the intracranial aneurysm clip-ping operation conduces to find the inadvertent occlusion or incomplete closure and the timely adj ust the aneurysm clip position;the IMD can assist operation can significantly improve the postoperative GOS score,short the hospital stay and reduce the reoperation rate and the probability of complication occurrence.