破裂脑动脉瘤显微手术夹闭后脑梗死临床分析

Study on cerebral infarction after operation in patients with intracranial aneurysm

目的研究破裂脑动脉瘤进行显微手术夹闭后发生脑梗死相关的影响因素,探讨预防措施。方法对本院神经外科自2000-01～2009-03施行显微夹闭手术的200例破裂脑动脉瘤病例临床资料进行回顾性分析,研究术后形成脑梗死的相关因素。结果本组200例施行动脉瘤夹闭手术,21例术后并发不同部位脑梗死,梗死发生率10.05%;深部单灶性梗死8例,皮层单灶梗死5例,深部多灶梗死3例,皮层多灶梗死3例,复合型梗死2例。采取预防措施者术后梗死率均低于总的梗死发生率,术中应用罂粟碱者术后梗死率为3.5%,缩短术中血管阻断时间(<10 min)者3.0%,术后有效释放血性脑脊液者4.0%。结论血液黏度、动脉硬化、血管痉挛、穿通支损伤、载瘤动脉损伤、血管阻断时间等是形成术后脑梗死的重要影响因素;而术中罂粟碱应用及控制血管阻断时间、减少术中脑组织牵拉伤、术后有效释放血性脑脊液等是预防梗死发生有效措施。

Objective To explore the pathogenetic mechanism and prevention of cerebral infarction after the operation in the patients with intracranial aneurysm.Methods The clinical materials of 200 cases with aneurysm surgery were retrospectively analyzed.Results Some 21 cases with cerebral infarction following operation were found in 200 cases.Eight cases were single deep cerebral infarction,5 cases were single cortical,3 cases were multiple deep,3 cases were multiple cortical,2 cases were multiple combined.Conclusion The occurrence of cerebral infarction after aneurysm surgery is correlated with blood viscosity,artery sclerosis,angiospasm vasospasm,injury of perforating branch,injury of artery carrying aneurysm,and interception of blood vessel,etc.If vigorous preventive measures are adopted during and after the neurosurgery,the postoperative incidence of the cerebral infarction may be significantly reduced.