颈动脉冷灌注下开颅手术的实验及临床研究

Laboratory and Clinical Study of Craniotomy with Carotid Artery Cool Perfusion

目的 :探索颈动脉冷灌注下的开颅手术对延长脑缺血耐受时间及保护脑功能的作用。方法 :在动物实验基础上 ,应用体外循环颈动脉冷灌注对 2例颅内动脉瘤和 4例血供丰富的巨大脑膜瘤进行开颅夹闭和摘除术。同侧脑温降至 2 3～ 2 8℃ ,维持 40～ 6 0 min。结果 :动脉瘤均夹闭成功。其中 1例术中破裂动脉瘤 ,经冷灌注后完全断流 2 0 min成功夹闭瘤颈。脑膜瘤均全切除。 1例为首次手术时因大出血而放弃切除 ,用此方法再次手术全切除。结论 :体外循环颈动脉冷灌注能较好地保护灌注区脑组织在缺血状态下的功能 ,延长脑缺血耐受时间。从而为断流或低流状态下夹闭动脉瘤等创造有利条件。

Objective:To observe the cerebral protection effect of carotid artery cool perfusion during craniotomy.Methods:Two cases of aneurysm and 4 cases of meningioma were operated with carotid artery cool perfusion and closed chest extracorporeal circulation.The brain temperature at 23～28℃ was maintained about 40～60 minutes during operation.Results:All 6 cases had good results with aneurysms clipped and meningiomas were removed totally.One aneurysm ruptured during operation was clipped sucessfully with blockage of homolateral carotid artery for 20 minutes after cool perfusion.One meningioma which could not be resected at first operation due to great blood loss was totally removed with this method.Conclusion:Carotid artery cool perfusion may prolong the period of blocking brain blood flow with cerebral protection.