麻醉管理在Hunt's Ⅳ~Ⅴ级破裂脑动脉瘤手术中的意义

Aesthetic Management of Ruptured Cerebral Aneurysm with Hunt's Ⅳ～Ⅴ Grade Sah

目的探讨Hunt’s高分级破裂动脉瘤手术中麻醉管理的意义。方法回顾性分析77例高级别破裂脑动脉瘤患者围手术期中的麻醉措施及其效果。术前维持正常生命体征,夹闭动脉瘤后适当升高血压,术后3月随访。结果术前呼吸障碍或呼吸困难的24例的患者经紧急抢救后得到缓解。麻醉诱导及插管阶段未发生脑动脉瘤再破裂。麻醉维持中血压等生命体征基本平稳,77例患者术后三个月时预后良好22例,中残12例,植物状态生存14例,死亡29例。结论高级别患者术前积极改善呼吸,术中平稳麻醉,术后防止血管痉挛和低血压有助于提高预后。

Objective To explore the anesthetic management in the early surgery of patient pressure altitude aneurysmal subarachnoid hemorrhage（SAH）. Methods The anesthetic methods and the efficiency perisurgery of patients with Hunt＇ s Ⅳ - Ⅴ grade SAH were analyzed retrospectively. The basic life signs were optimized. The blood pressure should be upgraded adequately after successful clipping of aneurysms. Follow-up started 3 months later. Results Twenty-four cases of respiratory handicap or difficulty were alleviated with emergency rescue. No intraoperative aneurysm rupture occurred during anesthetic induction and maintenance. The basic life signs were kept adequately in the anesthetic maintenance. The prognosis of 77 cases showed 22 of good outcome, 12 of moderate disability, 14 of vegetation survived and 29 of dead. Conclusion The better prognosis of patients with high grade SAH depends on the improvement of breathing preo-peratively, the stable anesthetic induction and maintenance intraoperatively, and to avoid vasospasm and hypotension postoperatively.