颅内动脉瘤介入栓塞术中动脉瘤破裂的围手术期麻醉管理

Perioperative anesthetic management of ruptured aneurysms during interventional intracranial embolization

目的总结接受颅内动脉瘤介入栓塞术中动脉瘤破裂患者的围手术期麻醉管理要点。方法回顾分析2019年1月1日至2023年7月10日于首都医科大学附属北京天坛医院进行颅内动脉瘤栓塞术,术中动脉瘤破裂患者的医疗记录。收集患者人口统计学、术中及术后相关信息。结果9例患者发生术中动脉瘤破裂。患者基础血压平均150 mmHg/80 mmHg(最低140 mmHg/70 mmHg,最高160 mmHg/90 mmHg,1 mmHg=0.133 kPa),动脉瘤破裂后血压平均200 mmHg/100 mmHg(最低160 mmHg/90 mmHg,最高220 mmHg/100 mmHg),收缩压变异系数20.2%(5.2%,26.5%)。3例患者在动脉瘤破裂后10 min内将血压控制在麻醉维持期血压水平,其余6例控制血压时间在20 min及以上。3例患者意识清醒拔除喉罩离室,6例患者保留气管插管离室。6例患者康复出院,1例患者转院后死亡,2例患者院内死亡。结论颅内动脉瘤术中破裂患者死亡风险高达33.3%,麻醉医师应提高认识,术前详细评估患者心血管情况,术中进行全面循环监测。在抢救过程中尽早控制血压,维持循环稳定,减少出血量是麻醉管理的重中之重。

Objective To summarize the key points of perioperative anesthetic management for patients with intraoperative aneurysm rupture during interventional intracranial aneurysm embolization.Methods Patients who underwent intracranial aneu⁃rysm embolization in Beijing Tiantan Hospital,Capital Medical University from January 1,2019 to July 10,2023 were enrolled and their medical data were retrospectively analyzed.Their demographic,perioperative and postoperative information was collected.Re⁃sults Intraoperative aneurysm rupture occurred in nine patients.Their average basal blood pressure was 150 mmHg/80 mmHg(mini⁃mum 140 mmHg/70 mmHg and maximum 160 mmHg/90 mmHg,1 mmHg=0.133 kPa).After aneurysm rupture,the average blood pres⁃sure was 200 mmHg/100 mmHg(minimum 160 mmHg/90 mmHg and maximum 220 mmHg/100 mmHg),and the variation coefficient of systolic blood pressure was 20.2%(5.2%,26.5%).After aneurysm rupture,three patients had their blood pressure controlled at the anes⁃thesia maintenance level within 10 minutes,while the other six patients had their blood pressure controlled at the anesthesia maintenance level within 20 min or more.Three patients were conscious enough to remove the laryngeal mask and left the operating room,while six pa⁃tients left the room with the endotracheal tube.Six patients recovered and discharged,one patient died after being transferred to another hospital,and two patients died in the hospital.Conclusions The risk of death for patients with ruptured aneurysm during intracrani⁃al aneurysm embolization is as high as 33.3%.Anesthesiologists should raise awareness,conduct a detailed preoperative assessment of the patient's cardiovascular condition,and perform comprehensive circulatory monitoring during surgery.During the rescue process,early control of blood pressure,maintenance of circulatory stability and reduction of blood loss are the top priorities of anesthesia man⁃agement.