血管内介入栓塞治疗后交通动脉瘤伴动眼神经麻痹对神经功能的影响

Effects of Endovascular Embolization on Nerve Function in Treatment Posterior Communicating Artery Aneurysms with Oculomotor Nerve Palsy

目的比较交通动脉瘤伴动眼神经麻痹在经血管内介入栓塞与开颅夹闭治疗中的临床效果。方法选取交通动脉瘤伴动眼神经麻痹患者72例,按照不同手术方式分为观察组及对照组,两组各36例。取血管内介入栓塞治疗的是观察组,择显微外科手术治疗的是对照组。对比两组手术相关指标、Glucose、NSE、IUPAC情况,以及术后动眼神经恢复、并发症发生率。结果手术后,观察组和对照组Glucose水平分别为(1.28±0.22)(1.73±0.40)mmol/l,IUPAC水平分别为(5.33±0.46)(6.77±1.22)mmol/l,NSE水平分别为(17.84±5.10)(26.13±8.92)μg/l,差异均有统计学意义(P<0.05);观察组患者手术时间、拔除导管时间和出血量均显著低于对照组,差异有统计学意义(P<0.05);观察组和对照组患者术后动眼神经恢复率分别为80.56%和63.89%,差异有统计学意义(P<0.05);两组患者出现主要并发症为脑水肿、脱水、脑梗死和血管痉挛,观察组和对照组并发症发生率分别为36.11%和55.56%,差异有统计学意义(P<0.05)。结论针对交通动脉瘤伴动眼神经麻痹患者,介入组在交通动脉瘤伴动眼神经麻痹患者治疗中比开颅夹闭更有优势,更具有临床应用价值。

Objective To compare the clinical effect of communicating aneurysm with oculomotor nerve paralysis in the treatment of transvascular interventional embolism and craniotomy.Methods 72 patients with communicating artery aneurysm complicated with oculomotor nerve paralysis were treated.They were divided into the observation group(n=36)and the control group(n=36)according to different surgical methods.The observation group was treated with intravascular interventional embolism,and the control group was treated by microsurgery.The operative related indexes,Glucose,NSE,IUPAC,oculomotor nerve recovery and the incidence of complications were compared between the 2 groups.Results After the operation,The levels of Guctose in the observation group and the control group were(1.28±0.22)(1.73±0.40)mmol/l,the level of IUPAC was(5.33±0.46)(6.77±1.22)mmol/l,and the level of NSE was(17.84±5.10)(26.13±8.92)mmol/l.The time and blood loss of the catheter were significantly lower than that of the control group(P<0.05),and the operation of the observation group and the control group was significantly lower than that of the control group(P<0.05).The incidence of complications of the 2 groups were cerebral edema,dehydration,cerebral infarction and vascular spasm,and the incidence of complications were 36.11%and55.56%,respectively.The difference was significant(P<0.05).Conclusion In the treatment of traffic aneurysm with oculomotor paralysis,the interventional group has more advantages than craniotomy in the treatment of traffic aneurysm with moving-eye nerve paralysis,and has more clinical application value.