脑动脉瘤破裂出血手术的麻醉处理

Anesthesia in surgery for ruptured intracranial aneurysm

目的：探讨脑动脉瘤破裂出血围手术期的麻醉处理。方法：采用静脉快速诱导气管内插管、普鲁卡因静脉复合全麻、控制性降压等方法处理。结果：２６例患者术后无１例并发再出血，２例死于脑血管痉挛，２例偏瘫，２例巨大复杂后交通动脉瘤的患者在深低温体外循环下手术获得成功，余２２例痊愈出院。结论：围手术期麻醉处理关键是：采取有效措施防止再出血和脑血管痉挛，深低温体外循环、控制性降压、降低颅内压、脑室穿刺引流术等均有利于提高治愈率。

Objective:Provide some current concepts related to the perioperative anesthetic management of patients with ruptured intracranial aneurysm Method:Twenty six consecutive patients with the diagnosis of ruptured intracranial aneurysm were included in this study The anesthetic management including rapid intravenous induction followed by tracheal intubation,procaine intravenous balanced anesthesia,controlled hypotension,intracranial pressure reduction,ect Result:no one complicated rebleeding,two cases died of cerebral vasospasm and two cases became disabled during postoperative periods Two cases with complex posterior circulation aneurysms were treated surgically smoothly under the deep hypothermic circulatory arrest Conclusion:The key of perioperative anesthetic management is to prevent rebleeding and cerebral vasospasm Deliberate deep hypothermic circulatory arrest,controlled hypotension,intracranial pressure reduction,cerebroventricular puncture cerebrospinal fluid drainage will optimize the outcome of ruptured intracranial aneurysm