颅内动脉瘤夹闭术围手术期血压管理与神经功能预后研究进展

Research advances on perioperative blood pressure management and neurological prognosis of intracranial aneurysm clip⁃ping

颅内动脉瘤破裂蛛网膜下腔出血导致颅内压急剧升高、脑血管痉挛(CVS)、延迟性脑缺血及神经功能损伤等风险显著增加。开颅夹闭术是动脉瘤的主要治疗手段之一,术中外科操作及围手术期管理与患者神经功能预后密切相关。围手术期麻醉医师应根据相应治疗阶段针对性采取适宜的血压管理措施,维持血流动力学稳定,避免手术相关并发症发生。文章拟对颅内动脉瘤夹闭术的术前、麻醉诱导期、术中夹闭前后、术后的血压管理及神经功能预后研究进展进行综述,为围手术期颅内动脉瘤夹闭术的血压管理提供理论依据与临床参考,以改善患者预后转归。

Aneurysmal subarachnoid hemorrhage leads to a sharp increase in intracranial pressure,which causes the risks of cerebral vascular spasm(CVS),delayed cerebral ischemia,and neurological deficits.Intracranial aneurysm clipping is a primary meth-od in the treatment of aneurysms.Intraoperative surgical procedures and perioperative management are closely associated with the neu-rological prognosis of patients.Anesthesiologists should take appropriate perioperative blood pressure management measures according to the corresponding treatment stages to maintain hemodynamic stability of patients and avoid the occurrence of complications related to aneurysm surgery.This review aims to summarize perioperative recommendations of blood pressure management in the order of pre-operative preparation,anesthesia induction,before and after aneurysm clipping,the postoperative period,as well as neurological prog-nosis of intracranial aneurysm clipping.This review also aims to provide a theoretical basis and clinical reference for blood pressure management in perioperative aneurysm clipping procedures so as to enhance patient prognosis.