数字减影全脑血管造影91例分析

Analysis on total cerebral angiography with digital subtraction angiography in 91 cases

目的:探讨DSA(数字减影)全脑血管造影术前准备、穿刺方法,导管操作术后处理及并发症防止等问题。方法:对收治的91例脑血管造影患者临床资料进行分析。结果:91例造影显示:动脉瘤73例(包括单发58例,多发15例,合并烟雾病4例,合并颅内血管母细胞瘤1个,合并颅内脑膜瘤1个,合并脑血管畸形1例,共检查出动脉瘤90个),动静脉畸形10例(合并颅内动脉瘤1例),烟雾病6例(包括单发1例及合并颅内动脉瘤4例),颈内动脉海绵窦瘘2例,硬脑膜动静脉瘘1例及阴性结果4例,阳性检出率95.7%。其中4例右侧股动脉穿刺失败,改为左侧重新穿刺后成功,3例术中出现脑血管痉挛,1例术中出现大脑中动脉远端栓塞,1例术后出现穿刺部位血肿,皮下瘀血17 cm×15 cm,无一例远端血管异常。结论:DSA是一项有较高风险的操作技术、需要医、技、护、患等多方面密切协作。术前教育、穿刺部位麻醉、穿刺方法、导管操作、术后压迫止血、并发症防止、术后护理等均是手术成功的关键。

Objective To explore the preoperation preparation,puncture method,postoperation manageme nt after duct operation,complication prevention and other problems of total cer ebral angiography with digital subtraction angiography（DSA）.Method The clinical data of 91 cases underwen t cerebral angiography was analyzed.Results DSA displayed;aneurysm in 73 cases（single aneurysm in 58,nu merous aneurysm in 15,complicating with moyamoya disease of 4,complicating w ith hemangioblastoma of 1,complicating with meningeoma of 1,complicating with cerebral vascular malformations of 1,the number of aneurysm was 90）.Arterioven o us malformation in 10 cases（complicating with intracerebral aneurysm of 1 case）.Moyamoya disease in 6 cases（single moyamoya disease in 2 cases and complicati n g with intracerebral aneurysm of 4）.Carotid-cavernuou fistula in 2 cases,dura l arteriovenous fistula in 1 case,4 cases with negative results,and the positiv e check-outing rate was 95.7%.Among them,4 cases were failed to puncture in r ig ht femoral artery,changed to left side,and got success.Three cases appeared c erebral vessel spasm during the operation,1 case appeared embolism at the dista l end of middle cerebral artery during the operation,1 case appeared hematoma i n puncturing part after the operation,the area of subcutaneou stagnant blood was 17 cm×15 cm,with no abnormality in distal end of blood vessel. Conclusion DSA is a high risk operation t echnique,which need the closely cooperation of doctor,nurse,technician and th e patients.Preoperation education,anaesthesia in puncture position,puncture m e thod,duct operation,oppressing to stop bleeding after operation,complication prevention,nursing after operation and so on are the key to successful operatio n.