中国微创外科杂志
中國微創外科雜誌
중국미창외과잡지
CHINESE JOURNAL OF MINIMALLY INVASIVE SURGERY
2015年
2期
97-100
,共4页
傅军%李选%韩金涛%王昌明%栾景源%吕献军%李天润%曲雯%冯琦琛%庄金满%马晓娟%隋玉洁
傅軍%李選%韓金濤%王昌明%欒景源%呂獻軍%李天潤%麯雯%馮琦琛%莊金滿%馬曉娟%隋玉潔
부군%리선%한금도%왕창명%란경원%려헌군%리천윤%곡문%풍기침%장금만%마효연%수옥길
蛛网膜下腔出血%脑血管造影术%动脉瘤栓塞%围术期
蛛網膜下腔齣血%腦血管造影術%動脈瘤栓塞%圍術期
주망막하강출혈%뇌혈관조영술%동맥류전새%위술기
Subarachnoid hemorrhage%Cerebral angiography%Aneurysm embolization%Perioperative period
目的：探讨颅内动脉瘤栓塞治疗的围手术期处理措施。方法2002年12月～2013年5月对210例颅内动脉瘤行弹簧圈栓塞，围手术期行脱水、解痉、脑复苏、控制输液、抗血小板等治疗。结果195例急性蛛网膜下腔出血和脑出血行全脑血管造影发现颅内动脉瘤并行急诊栓塞治疗（1例首次造影未发现动脉瘤，2 d后再次造影发现动脉瘤并成功栓塞）。围手术期死亡8例，致伤残4例，3例入院时昏迷，出院时基本恢复正常。190例平均随访43．5月（6～116个月），其中＞36个月130例，＞60个月90例：12例术后6～12个月复查发现新发及栓塞处动脉瘤扩大，行再次栓塞，复发率6．3％（12／190）；GOS平均4．6分（4～5分）；格拉斯哥昏迷评分（GCS）均为15分，术前平均13分（5～15分）。结论对于蛛网膜下腔出血者，应尽快行全脑血管造影术，可明确颅内动脉瘤的诊断和栓塞治疗；加强围术期的各种管理，如脱水、腰穿、抗痉挛、抗血小板治疗等措施可以加快患者康复并减少各种并发症的发生。
目的：探討顱內動脈瘤栓塞治療的圍手術期處理措施。方法2002年12月～2013年5月對210例顱內動脈瘤行彈簧圈栓塞，圍手術期行脫水、解痙、腦複囌、控製輸液、抗血小闆等治療。結果195例急性蛛網膜下腔齣血和腦齣血行全腦血管造影髮現顱內動脈瘤併行急診栓塞治療（1例首次造影未髮現動脈瘤，2 d後再次造影髮現動脈瘤併成功栓塞）。圍手術期死亡8例，緻傷殘4例，3例入院時昏迷，齣院時基本恢複正常。190例平均隨訪43．5月（6～116箇月），其中＞36箇月130例，＞60箇月90例：12例術後6～12箇月複查髮現新髮及栓塞處動脈瘤擴大，行再次栓塞，複髮率6．3％（12／190）；GOS平均4．6分（4～5分）；格拉斯哥昏迷評分（GCS）均為15分，術前平均13分（5～15分）。結論對于蛛網膜下腔齣血者，應儘快行全腦血管造影術，可明確顱內動脈瘤的診斷和栓塞治療；加彊圍術期的各種管理，如脫水、腰穿、抗痙攣、抗血小闆治療等措施可以加快患者康複併減少各種併髮癥的髮生。
목적：탐토로내동맥류전새치료적위수술기처리조시。방법2002년12월～2013년5월대210례로내동맥류행탄황권전새，위수술기행탈수、해경、뇌복소、공제수액、항혈소판등치료。결과195례급성주망막하강출혈화뇌출혈행전뇌혈관조영발현로내동맥류병행급진전새치료（1례수차조영미발현동맥류，2 d후재차조영발현동맥류병성공전새）。위수술기사망8례，치상잔4례，3례입원시혼미，출원시기본회복정상。190례평균수방43．5월（6～116개월），기중＞36개월130례，＞60개월90례：12례술후6～12개월복사발현신발급전새처동맥류확대，행재차전새，복발솔6．3％（12／190）；GOS평균4．6분（4～5분）；격랍사가혼미평분（GCS）균위15분，술전평균13분（5～15분）。결론대우주망막하강출혈자，응진쾌행전뇌혈관조영술，가명학로내동맥류적진단화전새치료；가강위술기적각충관리，여탈수、요천、항경련、항혈소판치료등조시가이가쾌환자강복병감소각충병발증적발생。
Objective To explore perioperative management of intravascular embolization therapy for cerebral aneurysm . Methods From December 2002 to May 2013, 210 cases of intracranial aneurysm underwent intravascular embolization therapy .The measures of comprehensive perioperative management included dehydration , antispasmodic , cerebral resuscitation , fluid resuscitation , antiplatelet, and so on. Results A total of 195 patients with subarachnoid or cerebral hemorrhage underwent cerebral angiography and intravascular embolization for cerebral aneurysm ( in 1 patient with negative findings of initial angiography , a re-examination was given 2 days later and aneurysm was confirmed and successfully embolized ) .Eight patients died after the operation , and 4 patients suffered from complications and were disabled .Three patients with coma when admitted were fully recovered after the therapy .Follow-up reviews for 6-116 months (mean, 43.5 months) were conducted in 190 cases, including >36 months in 130 cases and >60 months in 90 cases.Postoperative re-examinations found newly emerging or relapse of aneurysm in 12 cases at 6 -12 months after operation, which were given a second intravascular embolization , the recurrence rate being 6.3% (12/190).The GOS was 4-5 points (mean, 4.6 points), and the mean GCS was 13 points (5 -15 points) preoperatively and 15 points postoperatively. Conclusions Cerebral angiography should be actively undertaken for subarachnoid hemorrhage , which is essential for the diagnosis and embolization treatment of cerebral aneurysm .Perioperative management , such as dehydration , lumber puncture , anti-spasm, and anti-platelet, speeds the patients ’ recovery and reduces the complications .
