经颅多普勒评价不同手术方法对脑血管痉挛率的影响

Evaluation of postoperative cerebral vasospasm with transcr anial doppler ultrasound

目的：观察两种手术方法对５６例脑瘤患者术后脑血管痉挛率的影响。方法：利用经颅多普勒（ＴＣＤ）连续监测患者脑血液动力学。结果：部分患者术后有脑血管痉挛（ＶＳＰ）发生，显微手术后ＶＳＰ发生率（４．２％）明显低于传统手术（２８％），Ｐ＜０．０５。结论：显微手术优于传统手术。传统手术后ＶＳＰ与肿瘤部位、性质有关。两种手术方法对垂体瘤和鞍区颅咽管瘤的脑血液动力学影响均不明显。引起ＶＳＰ的主要原因是与脑损伤的程度及残留于蛛网膜下腔血量的多少有关。提高手术技巧、改进手术方法，以及加强术后处理完全能减少ＶＳＰ的发生率。

Objective:To observe the rate of cerebral vessal spasm after brain tumor operation with two different surgical approches. Mathods: Continuously measurement of cerebral hemodynamics by TCD postoperatively was done. Results: Some patients have VSP after craniotomy with incidence of 4 2% compared with 28% after conventional surgery (P<0 05). Conclusion: microsurgery superior traditional technique. In the two groups there is no VSP occured for pituitary adenoma and craniopharyngioma in sella region. the cause of VSP is primarily linked with the degree of brain injury and the blood amount remained in subarachnoid cisten. It also shows that VSP can certainly be decreased by the improvement of the surgery skill and method and the postoperation management.