多普勒血流探测仪在颅内动脉瘤夹闭术中的应用研究

Application of Doppler blood flow detector in intracranial aneurysm clipping

目的评价微血管多普勒血流探测仪在颅内动脉瘤手术中的监测效果。方法回顾性分析2015年7月至2017年7月120例颅内动脉瘤患者在开颅夹闭手术中,使用微血管多普勒超声1 mm微探头检测载瘤动脉和相关穿支动脉血流动力学的改变。根据血流信号,未行动脉瘤夹调整55例;处理动脉后,载瘤动脉或穿支动脉血流信号降低或消失时,改变动脉瘤夹夹闭位置65例,使载瘤动脉或穿支动脉的血流恢复至正常。对比分析动脉瘤夹调整前后,载瘤动脉的血流速度及搏动指数变化,并于术后1周对患者均行头部CT、血管成像(CTA)或全脑血管造影(DSA)复查。术后1、3和6个月随访DSA,评估术后效果。结果120例患者瘤颈残余及载瘤动脉梗阻率为3.3%(4/120),低于大宗病例5%的血管梗阻或瘤颈残余率。结论微血管多普勒血流探测仪具有安全、可靠、操作简单的特点。该技术有利于发现颅内动脉瘤开颅夹闭手术中的误夹或载瘤动脉夹闭不全,以便及时调整动脉瘤夹位置,提高手术疗效。

Objective To evaluate the monitoring effect of microvascular Doppler blood flow detector in intracranial aneurysm surgery.Methods One hundred and twenty patients with intracranial aneurysms from July 2015 to July 2017 who received craniotomy and used microvascular Doppler ultrasound 1 mm microprobe to detect the hemodynamics of the parent artery and related perforating artery change were retrospectively analyzed. According to the blood flow signal,aneurysm clip was not adjusted in 55 cases;when the tumor artery or perforator artery blood flow signal decreased or disappeared after treatment,aneurysm clip clamping position was changed in 65 cases,so that the blood flow of tumor artery or perforator artery returned to normal. The blood flow velocity and pulsation index (PI) of the artery was measured before and after adjustment of the aneurysm clip. The patients underwent CT angiography (CTA) or DSA examination 1 week after surgery. Angiography was performed to evaluate the postoperative results in one month,three months,and six months′ follow-up. The data obtained were statistically analyzed.Results Vascular obstruction or neck residual rate of 120 cases was lower than 5% vascular obstruction or residual neck residual rate in large cases.Conclusions The microvascular Doppler blood flow detector is safe,reliable and easy to operate. This technique is useful for finding the clips in the craniotomy of the intracranial aneurysm or the incomplete clamping of the tumor-bearing artery,so as to adjust the position of the aneurysm clip in time and improve the curative effect.