经数字减影血管造影行颅内动脉瘤栓塞术的麻醉体会

The experience of the anesthesia of the embolization for Intra cranial aneurysm through DSA

目的探讨经数字减影血管造影(DSA)行颅内动脉瘤电解可脱性弹簧圈(GDC)栓塞术的麻醉效果。方法22例经DSA行颅内动脉瘤GDC栓塞术的患者全部采用静脉快速诱导气管内插管,术中以微量泵持续泵注丙泊酚、瑞芬太尼,间断静脉注射维库溴铵维持肌松,持续泵注尼莫地平,以防血管痉挛,控制性降压等方法处理。结果22例经DSA行颅内动脉瘤GDC栓塞术的患者麻醉诱导、术中维持,术后苏醒平稳,控制性降压效果满意,无动脉瘤破裂。结论经DSA行颅内动脉瘤栓塞术麻醉处理的关键是:选择合适的麻醉药物,采取有效措施防止脑血管痉挛和动脉瘤再破裂,控制血压降低颅内压,以提高手术成功率。

Objective To investigate the effects of anesthesia GDC embolization operation for intracranial aneurysm through DSA. Methods Twenty-two cases were undergoing GDC embolization operation for intracranial aneurysm through DSA, they were anesthetized by fast vein induction and endotracheal tube. During the operation , the patients received continuing intravenous injection of propofol and remifentanil by micropump,and intermittent intravenous injection of vecuronium bromide to keep flaccidity. The patients also received continuing intravenous injection of Nimodipine by micro pump （to prevent vasospasm） and controlled hypotension and other methods in the operation. Results Twenty-two cases were undergoing GDC embolization operation for intracranial aneurysm through DSA were well through induction of anesthesia, maintenance of anesthesia and palinesthesia after the operation .the effect of controlled hypotension were well and the aneurysm had not rhexis. Conclusions The key point of the anaesthesia treatment of the embolization for intracranial aneurysm patient through DSA： to choose anesthetic properly, avoiding cerebral angiospasm and aneurysm rupture again, controlling blood pressure and lowering intracranial pressure in order to elevate achievement ratio of the operation.