血管内介入栓塞治疗对后交通动脉瘤伴动眼神经麻痹患者脑损伤及神经功能恢复的影响

Effects of endovascular embolization treatment on brain damage and recovery of neurological function in patients with posterior communicating artery aneurysm combined with oculomotor nerve palsy

目的探讨血管内介入栓塞治疗对后交通动脉瘤伴动眼神经麻痹患者脑损伤及神经功能的影响。方法郑州大学第一附属医院神经外科自2007年1月至2011年1月共收治后交通动脉瘤伴动眼神经麻痹患者84例，其中采用血管内介入栓塞治疗和显微外科手术治疗各42例，比较2组患者手术时间、术中出血量、术后恢复呼吸时间和拔除气管导管时间，手术结束时血清神经元特异性烯醇化酶（NSE）、葡萄糖和乳酸水平，出院时患者动眼神经的恢复和并发症的发生情况。结果血管内介入栓塞治疗组患者手术时间、术中出血量、术后拔除气管导管时间，手术结束时血清NSE、葡萄糖和乳酸水平，术后脑血管痉挛、脑水肿的发生率均低于显微外科手术治疗组，差异有统计学意义（P〈0．05）。2组患者术后动眼神经完全恢复率的差异无统计学意义（P〉0．05）。结论与显微外科手术比较，血管内介入栓塞治疗后交通动脉瘤伴动眼神经麻痹时出血和并发症少、恢复快，改善动眼神经麻痹的效果相当。

Objective To explore the effects of endovascular embolization treatment on brain damage and recovery of neurological function in patients with posterior communicating artery aneurysm combined with oculomotor nerve palsy. Methods Eighty-four patients with posterior communicating artery aneurysm combined with oculomotor nerve palsy, admitted to our hospital from January 2007 to January 2011, were chosen in our study; 42 of them used intravascular interventional therapy （group A） and other 42 used microsurgical treatment （group B）; the operation time, intraoperative blood loss, time of postoperative recovery respiratory and postoperative extubation time between the groups were compared; and the levels of serum neuron specific enolase （NSE）, glucose and lactic acid at the end of the operation, postoperative recovery of the oculomotor nerve palsy and postoperative complications at discharge of the hospital were observed and compared between the two groups. Results As compared with group B, group A had significantly shorter operation time and postoperative extubation time （P〈0.05）, and significantly less intraoperative bleeding （P〈0.05）; NSE, glucose and lactic acid levels in group A were significantly lower than those in group B at the end of the operation （P〈0.05）; the incidence of cerebral vasospasm and cerebral edema in group A were obviously lower than that in group B （P〈 0.05）. The complete recovery of oculomotor nerve paralysis showed no significant difference between the two groups （P〉0.05）. Conclusion As compared with microsurgical treatment, intravascular interventional therapy has good effects （no bleeding, rapid recovery and few complications） in patients with posterior communicating artery aneurysms combined with oculomotor nerve palsy.