颈内静脉结扎后颅内压变化的实验研究

Experimental Study on Effect of Intracranial Pressure after Jugular Vein Ligation

目的：为了解颈内静脉结扎对颅内组织器官的影响及其时间和范围，探索颈内静脉结扎后并发症发生的机理，从而指导颈内静脉结扎的围手术期处理．方法：采用新西兰大白兔作为实验对象，设立空白对照、单纯左侧及右侧和双侧颈内静脉结扎４组，于术前及术后４８小时内监测颅内压变化及１周后脑组织病理改变．结果：对照组手术前后颅内压无明显改变；单侧颈内静脉结扎后颅内压均有上升，在术后１小时达高峰并持续至术后４小时开始下降（Ｐ＜０．０５），术后４８小时恢复至术前水平；而双侧颈内静脉结扎者术后颅内压则显著上升，术后 ２，小时达高峰并持续至４８小时还高于术前（Ｐ＜０．０５）． １周后脑组织病理检查发现对照组及单侧颈内静脉结扎者无明显改变；双侧颈内静脉结扎者有颅内广泛胶质细胞增生．结论：单侧颈内静脉结扎后颅内压均有一过性上升，双侧颈内静脉结扎后颅内压上升显著且持续时间长．建议一般不要结扎双侧颈内静脉，颈内静脉结扎后４８小时内应严密观察病情，必要时测定颅内压及血液粘度并使用降低颅内压及血液粘度的药物．

Objective: To investigate the changes of intracranial pressure (ICP) after jugular vein ligation and to guide the treatment of the patient who suffered from jugular vein phlebectasia (JVP) before and after the operation of jugular vein ligation (JVL). Methods: 24 rabbits were divided into 4 groups randomly that were taken for right, left, bilateral JVL and blank control respectively. JVL operations of this animal study had been performed just as clinical treatment process of JVP. Lumbar puncture technique was employed to get the values of ICP pre and 48 hours postoperatively. Results: ICP increased 1 hour after unilateral JVL and lasting 4 hours. After bilateral JVL ICP increased immediately and was lasting 48 hours. Conclusions' The values of ICP may increase after JVL. The patient suffered from unilateral JVP could be treated with JVL but care must be taken to prevent postoperative complications such as intracranial hypertension and thrombosis. Medical dacron cloth packing of distended vein may be taken as an alternative procedure and medication for high blood viscosity was also needed, especially for patient with bilateral JVP or with high blood viscosity.