术中颅内动脉瘤破裂的预防及应急处理

PREVENTION AND EMERGENCY MANAGEMENT FOR RUPTURE OF INTRACRANIAL ANEURYSM DURING SURGERY

对58例颅内动脉瘤手术,术中7例动脉瘤破裂,阻断供血动脉血流,用刮匙摄子夹闭有破裂口的瘤体或瘤颈后,有效地控制了出血。作者认为手术应保持良好的术野,采用控制性低血压,头位固定及做好预防术中动脉瘤破裂的准备。

This paper presents the experience of prevention and emer- gency management of rupture of the intracranial aneurysm during direct operation.The rupture occurred in seven of the 58 cases during the direct procedure.Emergency management was successfully used to control the bleeding so that the seven patients with the rupture of aneurysm were out of danger.We think it very important that the control of hypotension anaesthesia,fixed head position,preparation of temporary block of blood flow of the supply artery as well as operating microscope should be used to improve accurate procedure for preventing the rupture of aneurysm.Once the rupture of aneurysm occurs,the operators should keep calm and have the operation field well exposed,and what is more important,the flow of supply artery should be blocked without a moment′s delay.According to our experience that we had in the use of the special long jaw genu forceps spoon-shaped(Graping forceps)to clip the neck or the body of aneurysm temporarily,the bleeding can be effectively stopped.In this way,the persistent surgical clip can be put at the neck of aneurysm easily.The technique mentioned above was successfully practised in six of the seven patients with the rupture of aneurysm in our series.