亚低温对颅内巨大动脉瘤夹闭术临时阻断动脉血流及缺血-再灌注期的脑保护作用

The effect of mild hypothermia on cerebral protection during temporarily blocking parent arteries of intracranial giant aneurysm and ischemia-reperfusion period

目的观察亚低温对颅内巨大动脉瘤夹闭手术中临时阻断动脉血流及缺血-再灌注期的脑保护作用。方法1998年9月-2002年6月施行颅内巨大动脉瘤夹闭手术患者27例,其中13例于动脉瘤夹闭临时阻断动脉血流及缺血-再灌注期行亚低温处理(亚低温组),脑温为32.0℃～35.0℃,同时监测生命体征、脑组织温度和失血量;另14例常温下手术者(常温组)作为对照,其他均同亚低温组。两组均于术后3个月根据GOS进行预后评估。结果术中两组患者生命体征变化差异无显著性意义(P>0.05)。亚低温组,神经功能伤残评定等级为良好11例(84.62%),轻残1例(7.69%),死亡1例(7.69%);常温组,神经功能伤残评定等级为良好6例(42.86%),轻残4例(28.57%),重残2例(14.29%),死亡2例(14.29%),组间差异具有显著性意义(Z=2.083,P<0.05)。结论亚低温可降低颅内巨大动脉瘤夹闭术患者的病死率,提高患者生命质量,对脑缺血及再灌注性损伤具有良好的脑保护作用。

Objective To observe the effect of mild hypothermia on cerebral protection during temporarily blocking partent arteries of intracranial giant aneurysms and ischemia-reperfusion period. Methods Of twenty-seven patients with intracranial giant aneurysm who underwent clipping operations during September 1998 to June 2002, thirteen were treated with mild hypothermia during temporarily blocking parent arteries and ischemia-reperfusion period (mild hypothermia group), in whom the brain temperature was always kept at 32.0℃-35.0℃, meanwhile, the vital signs, brain tissue temperature and blood loss were monitored. The other 14 patients were enrolled as control and underwent the same treatment as those in mild hypothermia group. The patients in both groups were evaluated with Glasgow outcome scale (GOS) system in 3 months after operations. Results The vital signs of patients during operation in both groups showed no significant difference (P > 0.05). In mild hypothermia group, good recovery (GOSⅠ) was found in 11 (84.62%) patients, mild disability (GOS Ⅱ) in 1 (7.69%) and death (GOS Ⅴ) in 1 (7.69%); while in control group, good was in 6 (42.86%), mild disability was in 4 (28.57%), severe disability in 2 (14.29%) and death in 2 (14.29%). Intergroup difference was significant (Z = 2.083, P < 0.05). Conclusion Mild hypothermia can provide effective protection for ischemia-reperfusion cerebral injury, remarkably reduce the mortality, and improve the quality of life in patients with giant aneurysms after clipping operations.