颅内动脉瘤术中临时阻断载瘤动脉的临床研究

Clinical study of temporary parent arterial occlusion in intracranial aneurysm surgery

目的探讨颅内动脉瘤手术中载瘤动脉临时阻断后继发脑缺血性脑功能损伤的相关因素。方法128例患者的130个动脉瘤临时阻断载瘤动脉,术后根据相应部位有无脑功能障碍,CT检查阻断血管供应区有无新鲜梗塞灶为标准判断是否造成缺血性脑损伤,并将性别、年龄、有无蛛网膜下腔出血、Hunt-Hess分级、动脉瘤的大小、部位、手术时机、阻断部位、时间、次数、方式、术中破裂、有无高血压、高血糖、载瘤动脉硬化斑块等14种因素进行单因素分析、探讨动脉阻断后可能导致缺血性损伤的原因。结果在130个动脉瘤中,共临时阻断166次,平均每个动脉瘤阻断1.28次,阻断时间为3～45min,平均每个动脉瘤阻断时间约为(9.8±7.8)min,有18例术后出现与载瘤动脉阻断有关新的脑缺血灶(14.06%),单因素分析显示年龄≥60岁、蛛网膜下腔出血、阻断时间≥20min和动脉硬化斑块对术后发生脑缺血具有较高危险性(均P<0.05)。结论载瘤动脉临时阻断继发缺血性脑损伤与阻断部位、阻断时间、阻断方式、侧支循环的个体差异、病人术前状况等因素有关。阻断时间<20min,临时载瘤动脉阻断是安全的。

Objective To identify the correlation factors associated with cerebral iatrogenic ischemia after temporary arterial occlusion （TAO） in intracranial aneurysm surgery. Methods 128 patients who underwent TAO in 130 aneurysms were reviewed retrospectively. The postoperative cerebral ischemia was diagnosed by CT scanning in which the newly developed low density area was found or by the clinical neurological deficit. These variables included sex, age, presence of preoperative subarachnoid hemorrhage （SAH） , neurological clinical grading, operational timing, duration of TAO, numbers of TAO, mode of TAO, intraoperative aneurysm rupture, hypertension, the location of TAO, aneurysm size, hyperglycemia , atheromatous mass. Univariate anelysis were used to investigate the relationship between the variates and postoperative ischemic results. Results The total case - times of TAO were 166 , with an average of 1.3. The duration of TAO ranged from 3 to 45 min （9. 75 ± 7. 75） . Eighteen patients （14.06 %） demonstrated evidence of new infarction in the vascular territory subjected to TAO. Conclusions The related factors associated with cerebral iatrogenic iscbemia after TAO in intracranial aneurysm surgery include the duration of TAO, the different artery occluded, the use of eontinue or intermittent occlusion, the individual differeuee of eollaterat artery and preoperative clinical grading of the patient. Based on these findings , TAO is safe and useful in aneurysm surgery and the postoperative cerebral ischemia is less likely to occur when the duration of TAO is shorter than 20 min.