影响载瘤动脉临时阻断后脑缺血性损伤的有关因素分析

Analysis on correlation factors of cerebral intragenic ischemia after temporary parent arterial occlusion during intracranial aneurysm surgery

目的 探讨颅内动脉瘤手术中可能导致载瘤动脉临时阻断后脑缺血损伤的有关因素。方法 1996-2 0 0 2年在3 2 4例动脉瘤手术中,118例患者的12 0个动脉瘤应用了载瘤动脉临时阻断。将性别、年龄、蛛网膜下腔出血、临床分级、手术时机、阻断时间、阻断次数、阻断方式、术中破裂、高血压、阻断部位、动脉瘤的大小、高血糖、载瘤动脉硬化斑块等14种因素进行单因素和多因素分析显示与术后发生脑缺血关系。结果 在118例患者12 0个动脉瘤中,共临时阻断15 6次,平均每个动脉瘤阻断1 3 0次,阻断时间为1～45min ,平均每个动脉瘤阻断时间的为(9 75±7 75 )min ,有17例术后出现与载瘤动脉阻断有关新的脑缺血灶(14 4% )。结论 单因素分析显示年龄、蛛网膜下腔出血、阻断时间和动脉硬化斑块对术后发生脑缺血具有较高危险性,多因素分析显示年龄大于60岁(P =0 0 10 3 ,OR =4 3 3 5 )、阻断时间大于2 0min (P =0 0 3 2 9,OR =4 177)两种因素与术后脑缺血损害的发生有显著性差异,因此,在阻断时间较短时(<2 0min) ,临时载瘤动脉阻断是安全的,不会导致术后脑缺血。

Objective To identify the correlation factors associated with cerebral intragenic ischemia after temporary parent arterial occlusion in intracranial aneurysm surgery. Methods One hundred and eighteen patients who underwent temporary arterial occlusion in the 120 aneurysms (from a group of 324 consecutive aneurysm patients treated from 1996 to 2002) were reviewed retrospectively. These variables included sex, age, presence of preoperative subarachnoid hemorrhage (SAH), neurological clinical grade, operational timing, duration of arterial occlusion, numbers of temporary occlusion, mode of arterial occlusion, intraoperative aneurysm rupture, hypertension, the location of temporary occlusion, aneurysm size, hyperglycemia, atheromatous mass. Univariate and multivariate were used to investigate the relationship between the variates and postoperative ischemic changes. Results The total times of temporary occlusion were 156, with an average of 1.30. The duration of arterial occlusion ranged from 1 to 45 min (9.75±7.75). Seventeen patients (14.4%) demonstrated evidence of new infarction in the vascular territory subjected to temporary arterial occlusion. Conclusion In the univariate analysis, age, presence of preoperative SAH, duration of arterial occlusion, atheromatous mass are all significantly correlated with postoperative ischemic injuries. Multivariate logistic regression revealed that the age, older more than 60 (P= 0.010 3 , relative risk=4.335), and the duration of arterial occlusion, lasting more than 20 min (P= 0.032 9 , relative risk=4.177), have significant correlation with the injuries. Based on these findings, temporary occlusion is safe and useful in aneurysm surgery and the postoperative cerebral ischemia is less likely to occur when the duration of clipping is shorter than 20 min.