颅内动脉瘤夹闭术的麻醉处理

The Perioperative Anesthesia Management of the Intracranial Aneurysms Surgery

目的：探索颅内动脉瘤夹闭术的麻醉处理方法。方法：采用静脉快速诱导气管插管、静吸复合维持麻醉,维持适当的颅内动脉跨壁压预防瘤体破裂,围术期采用钙通道阻滞剂预防脑血管痉挛,采取脑保护措施预防神经系统并发症,对65例颅内动脉瘤患者进行麻醉处理。结果：全部患者麻醉均成功,无手术死亡病例。术中动脉瘤破裂2例,通过外科医师放置临时动脉夹或者短时压迫同侧颈动脉来控制出血；同时胶体扩容,采用自体血回输机回输自体血；血管活性药物泵注,保持尿量＆gt;1-2 ml/kg/h,最终顺利完成手术。结论：麻醉诱导平稳,谨慎地控制血管的跨壁压,术前及术中预防脑血管痉挛并脑并发症是麻醉成功的关键。

[ Abstract] Objective： To investigate the perioperative anesthesia management of the surgery for intracranial aneu-rysm. Methods：Inhalation-intravenous anesthesia was applied after intravenous rapid induction of endotracheal intubation. Proper intracranial arterial pressure was maintained to prevent the rupture of aneurysms. Calcium channel blockers were a-dopted to prevent the cerebrovascular spasm and brain protection measures were used to prevent neurosystem complications. Totally 65 cases of intracranial aneurysm were involved in this study. Results：All patients successfully underwent the an-esthesia without operation related death. Intraoperative aneurysm rupture occurred in 2 cases. Bleeding was controlled by placing temporary artery clamp or ipsilateral carotid artery oppression. At the same time, colloid was added to expand plas-ma volume . Autologous blood was transfused with cell saver. Vascular active drugs were injected with pump to maintain the urine output＆gt;1~2 ml/kg/h. Conciusion：The keys of perioperative anesthesia management of intracranial aneurysm are ideal control of arterial pressure, prevention of cerebrovascular spasm and neurological complications pre-and intra-oper-atively.