电解可脱弹簧圈栓塞颅内动脉瘤术中颅内压、脑氧和脑糖代谢的变化

Intraoperative effect of ICP, cerebral oxygen and glucose metabolism in interventional endovascular treatment of intracranial aneurysms with Guglielmi detachable coil

目的 对比观察血管内栓塞和开颅夹闭治疗颅内动脉瘤对病人术中颅内压、脑氧和脑糖代谢的影响。方法 选择Hunt分级为Ⅰ～Ⅲ级的脑动脉瘤择期手术 4 4例 ,按治疗方法分为电解可脱弹簧圈 (GDC)栓塞 (Ⅰ组 )和开颅脑动脉瘤夹闭 (Ⅱ组 ) ,各 2 2例。分别观察麻醉后手术前 (T0 )、脑动脉瘤夹闭前 (GDC栓塞前 ,T1)和夹闭后 10min(GDC栓塞后 ,T2 )等时相脑脊液压 (CSFP)、动脉瘤跨壁压 (TMP)和脑氧、脑糖代谢等指标及术毕麻醉恢复情况。结果 Ⅰ组 :与T0 比较 ,T1和T2 的颈内静脉球部血氧饱和度 (SjvO2 )明显增加 ,脑氧摄取率 (ERO2 )减少 ,差异具有显著性 (P <0 0 5 ) ,脑动静脉血糖差 [D(a jv)BG]、乳酸浓度差 [D(a jv)BL]和血氧差 [D(a jv)O2 ]等指标无明显变化 (P >0 0 5 )。Ⅱ组 :与T0 比较 ,T1和T2 的D(a jv)BL和D(a jv)BG增加 ,D(a jv)O2 减少 ,差异具有显著性意义 (P <0 0 5 ) ,SjvO2 和ERO2 差异无显著性意义 (P >0 0 5 )。Ⅰ组 :与T0 比较 ,T1和T2 的CSFP和TMP无明显变化 (P >0 0 5 )。Ⅱ组 :与T0 比较 ,T1和T2 的CSFP降低 ,TMP增加 ,差异具有显著性 (P <0 0 5 )。与Ⅰ组比较 ,Ⅱ组T1和T2 相应时相的CSFP降低 ,TMP增加 ,差异具有显著性意义 (P <0 0 5 )。与Ⅱ组比较 。

Objective To compare the effects of interventional endovascular treatment with Guglielmi detachable coil (GDC) and surgical clipping on lumbar cerebrospinal fluid pressure (CSFP), cerebral oxygen, and glucose metabolism in the treatment of intracranial aneurysms.Methods Forty-four Hunt Grade Ⅰ～Ⅲ patients with intracranial aneurysms were divided into interventional endovascular group (groupⅠ,22 cases) and surgical clipping group (groupⅡ, 22 cases). A catheter placed in subarachnoid space was used to measure CSFP. Mean arterial pressure (MAP), CSFP, and transmural pressure (TMP) were monitored at baseline(T 0), before (T 1), and 10 min after endovascular embolization or clipping aneurysms(T 2). Meanwhile, blood samples were draw from radial artery and internal jugular bulb vein to determine the blood glucose and blood lactate level. The following variables were recorded after awakening: time until autonomous breathing and time until pull out tracheal tube.Results In groupⅠ, the blood oxygen saturation of internal jugular bulb vein (SjvO 2) was increased significantly (P<0.05) and cerebral oxygen extraction rate (ERO 2) was decreased significantly (P<0.05) at T 1 and T 2 compared with those at T 0. At T 1 and T 2, no changes occurred to the radial artery to internal jugular bulb vein difference for blood glucose [D(a-jv)BG], blood lactate level [ D(a-jv)BL], and oxygen content [D(a-jv)O 2] compared with those at T 0. While in groupⅡ, at T 1 and T 2, the aBG, jvBG, and D(a-jv)BL increased significantly (P<0.05), D(a-jv)O 2 decreased significantly (P<0.05), and SjvO 2, D(a-jv)BG, and ERO 2 had no differences compared with those at T 0. In groupⅠ, CSFP and TMP showed no changes throughout embolization of intracranial aneurysms with GDC. In groupⅡ, at T 1 and T 2, CSFP decreased significantly, and TMP, jvBG, and aBG increased significantly (P<0.05) compared with those at T 0. Comparing with in group Ⅰ, CSFP decreased significantly and TMP increased significantly (P<0.05) at T 1 and T 2 in group Ⅱ. Recovery times of autonomous breathing and of pull out tracheal tube were shorter in groupⅠthan in groupⅡ.Conclusion Embolization of intracranial aneurysms with GDC can help to maintain stable CSFP, TMP, cerebral oxygen, and glucose metabolism.