前交通动脉瘤切除术中临时血管夹闭对患者认知功能的影响

Effect of temporary vessel clipping on cognitive functions in patients with surgical excision of anterior communicating artery aneurysm

目的探讨前交通动脉(ACoA)瘤破裂引起的蛛网膜下腔出血病人手术切除动脉瘤临时血管夹闭对大脑额叶功能的影响。方法选择61例ACoA瘤破裂出血后96 h内进行早期手术的病人,所有病人手术前的Hunt-Hess评分1或2分,其中33例在切除动脉瘤时给予临时血管夹闭(A组),28例没有进行血管夹闭(B组);另选30例年龄相匹配的无神经或精神疾病的住院病人作为对照组(C组)。结果 A组病人临时血管夹闭的平均持续时间为(7.9±2.7)(6～15)min,临床或放射学检查无明显卒中,但长期随访发现有持续的认知功能缺损的表现,尤其是血管夹闭持续时间>9 min者。B组病人长期随访未发现额叶功能损害的表现。结论 ACoA瘤破裂出血后,手术切除动脉瘤进行临时血管夹闭对缺血性损害之前发生的认知改变有负性影响,强调外科医生在手术时应注意夹闭时间,以免造成永久性认知功能损害。

Objective To explore the effect of temporary vessel clipping on frontal lobe functions in patients with surgical excision aneurysm,which of anterior communicating artery（ACoA） aneurysm ruptured led to subarachnoid hemorrhage（SAH）.Methods Sixty-one patients with ruptured ACoA aneurysm underwent surgery within 96 hours after bleeding were chosen.All of them were in Hunt-Hess scale grade 1 or grade 2 before treatment.Among them,33 patients used temporary vessel clipping（group A）,and 28 patients didn＇t use temporary vessel clipping（group B）.In additional,we made a choice of 28 patients which ages well-matched with group A and group B,and without neurologic or psychiatric disorders（group C）.Results The mean duration of temporary vessel occlusion for group A was（7.9±2.7）minutes（6～15 minutes）.Neither clinical nor radiographic strokes were detected,and cognitive deficits were persisting at long-term follow-up in group A,especially in patients who had temporary vessel clipping duration longer than 9 minutes.Frontal lobe functions damaged was not found in group B at long-term.Conclusion After ruptured ACoA aneurysm,the treatment of surgical excision aneurysm with temporary vessel occlusion,and generate negative effects on cognitive changes occur before ischemic damage.The results emphasize that surgeon should attend vessel occlusion time,and to avoid creating adverse outcomes of permanent cognitive impairment.