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颅内破裂动脉瘤夹闭术后脑缺血损伤的综合防治
王明蒋宇钢
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摘要:
目的 探讨如何有效地防治颅内破裂动脉瘤夹闭术后脑缺血损伤。方法 回顾性分析我 科2014~2017年连续收治的389例破裂动脉瘤夹闭术后患者的病历及影像资料,研究术后脑缺血损伤的 具体原因及防治方法。结果 389例破裂动脉瘤夹闭术后共有27例患者发生脑缺血损伤,发生率为6.9%, 其中早期脑缺血损伤12例,晚期脑缺血损伤15例。脑缺血损伤主要与术中穿支血管损伤、脑血管痉挛、 临时阻断、分水岭脑梗死、脑血栓有关,早期脑缺血损伤主要与穿支血管损伤有关,晚期脑缺血损伤主要 与脑血管痉挛有关。结论 术中联合多普勒血管超声、神经内镜、神经电生理监测可有效降低术中穿支 血管的损害、载瘤动脉的狭窄和临时阻断所带来的缺血性脑损害;术中避免过多的血管操作、清除血肿 和蛛网膜下腔出血、术后腰大池引流血性脑脊液等均可有效预防脑血管痉挛,3H疗法能明显降低脑血管 痉挛所致的缺血性脑损害。
关键词:  动脉瘤,破裂  脑缺血损害  血管痉挛,颅内
DOI:10.3969/j.issn.1009-6574.2017.10.013
基金项目:
Comprehensive prevention and control of ischemic brain injury after intracranial rupture of aneurysmclipping
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Abstract:
Objective To investigate effective prevention and treatment of ischemic brain injury( IBI) after ruptured aneurysm clipping. Methods By retrospectively analyzing 389 cases of ruptured aneurysm clipping patients’ clinical and image data, who were admitted to our ward from 2014 to 2017, it explored the specific causes and prevention methods of postoperative cerebral ischemic injury. Results There were 27 patients suffered IBI among 389 cases of ruptured aneurysm clipping, with the incidence rate 6.9%, and there were 12 cases of early IBI and 15 cases of late IBI. The main reasons for IBI were the damage of perforating branches, cerebral vasospasm, temporary vascular occlusion, watershed infarction and cerebral thrombosis. Early IBI was mainly caused by the damage of perforating branches, while late IBI was mainly caused by the cerebral vasospasm. Conclusions Combination with application of Doppler ultrasonography,neuroendoscopy, neurophysiological monitoring( NEPM) can effectively decrease the damage of perforating branches, the ischemic brain damage caused by parent artery stenosis and temporary vascular occlusion. It is also suggested in the research that reducing excessive handling on vessels, removing the hematoma and subarachnoid hemorrhage and discharge the hemorrhagic cerebrospinal fluid by lumbar subarachnoid catheter can effectively prevent cerebral vasospasm. 3H treatment can significantly reduce ischemic brain damage brought by cerebral vasospasm.
Key words:  Aneurysm, ruptured  Ischemic brain injury  Vasospasm, intracranial

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