脑正常灌注压突破综合征7例报道及治疗体会

Management of seven normal perfusion pressure breakthrough syndrome

目的探讨部分脑外科患者手术后病变邻近脑组织发生正常灌注压突破综合征(NPPB)的可能发病机制、防止其发生的手术技巧以及对降低并发症的影响。方法对2001至2011年脑部手术治疗后出现的7例脑正常灌注压突破综合征患者的临床资料进行回顾性分析。结果所有患者术前均进行了CT、MRI或DSA的检查。7例病例均显微镜下切除病灶,3例清除血肿同时切除病灶,2例行术前造影,然后手术切除病灶。出院时疗效优良共2例(28.5%),病残3例(42.80%),死亡2例(28.5%)。病灶周围的脑组织内病理解剖可见病理性血管,血管周围的星形细胞足突明显减少或破坏。结论当血液灌注压力突然加大时,病变周围的病理性血管就可能发生破裂或液体外渗而发生正常灌注压突破并发症。正确地掌握显微外科手术技巧,对预防及减轻NPPB,降低病死率是有益的。

Objective To analyze the possible pathogenesis of normal perfusion pressure breakthrough syndrome （NPPB） which took place in brain tissue adjacent to the operative loci after operation, and the effect of improvement of surgical skills in the complication prophy- laxis. Methods The clinical data of 7 patients with NPPB from 2001 to 2011 after operation were retrospectively analyzed. Results Pre- operative examinations included CT and MRI or CTA in all patients, and DSA in 3 cases. All the 7 cases were radically excised under micro- scope. The symptom was improved in 2 cases （28.5%）, disabled in 3（42.8%）, and 2（28.5%） patients died. Pathological vessels in the brain tissue adjacent to the operative loci were observed. Pathological changes were observed at the capillary vascular basement and the feet of astro- cytes decreased or were damaged obviously. Conclusion The liquid effusion from the pathological capillary and some ruptured vessels as the blood pressure increased suddenly might cause the NPPB. Proper surgical skills such as microsurgical skill under microscope are beneficial to prevent the occurrence of NPPB and reduce the operative mortality.