诱发颅内动脉瘤破裂出血的危险因素及护理对策

目的:探讨诱发颅内动脉瘤破裂出血的危险因素及护理对策。方法:回顾性调查我科收治的颅内动脉瘤破裂出血病例,分析其诱发因素,提出护理对策。结果:本病与情绪紧张、剧烈活动、吸烟、饮酒及季节变换等有密切关系。结论:稳定患者情绪,控制好患者血压,作好防止颅内压增高的一切护理措施非常重要。

COMPLICATION ANALYSIS OF INTRACRANIAL ANEURYSM EMBOLIZATION WITH CONTROLLABLE COILS

Objective To explore the causes, prevention, and management of the complications during intra-cranial aneurysm embolization with controllable coils (mechanical detachable spiral, MDS; and Guglielmi detachable coil, GDC). Methods Retrospective review of 120 cases with 125 intracranial aneurysms embolized with con-trollable coils from March 1995 to July 1999 was conducted. The 20 accidents(in 18 cases) including aneurysm rupture, over-embolization, protrusion of coil end into the parent artery, and thrombosis of the parent artery were analyzed. Results Among the 20 accidents, there were 6 aneurysm ruptures, 6 over-embolizations (in 5 cases), 6 coil protrusions, and 2 thromboses (one was secondary to coil protrusion). The embolization-related mortality was 3.33% (4/120), the permanent neurological deficit was 1.67% (2/120), and the transitory neurological deficit was 3.33%(4/120). The occurrence and outcome of the complications were related to the embolizing technique, the pattern of aneurysm and its parent artery, the imperfection of embolic materials, and the observation and management during embolization. Conclusion Skilled embolizing technique, better understanding of the angio-anatomy of an aneurysm and its parent artery, correct judgement and management during embolization, and improvement of embolic materials are beneficial to the reduction of complications and to the melioration of the outcome of complications.

INITIAL COMPARISON OF INTRACRANIAL ANEURYSM EMBOLIZATION WITH MECHANICAL DETACHABLE SPIRALS AND WITH GUGLIELMI DETACHABLE COILS

Objective. To compare the embolization effects of intracranial aneurysms with mechanical detachable spirals (MDS) and with Guglielmi detachable coils (GDC).Methods. One hundred and twenty cases with 125 intracranial aneurysms were embolized in Beijing Hospital from March 1995 to July 1999. Sixty - six aneurysms in 64 cases were embolized with MDS, 51 in 48 with GDC, and 8 in 8 with both MDS and GDC. Clinical data including sex, age, subarachnoid hemorrhage (SAH), Hunt & Hess grading, diameter and neck width of aneurysms, number and length of coils used per aneurysm, occlusive ratio, and complications were compared between MDS and GDC groups.Results. MDS and GDC groups were comparable (t-test or x2 -test, all P value > 0. 10) in terms of age, sex, diameter of aneurysms [ (8. 46 ± 3. 42) mm vs. (7. 38 ± 3. 45) mm], neck width [ (3. 49 ± 1. 50) mm vs. (3. 26 ± 1. 52) mm], coils number[ (4. 65 ± 3. 01) vs. (4. 24 ± 2. 65) ] and their length[ (460. 2 ± 398. 5) mm vs. (422. 9 ±387. 1) mm] used per aneurysm, occlusive ratio in aneurysms embolized ≥80% [ (95. 00% ± 6. 32% ) vs. (94. 19% ± 7. 63% ) ], mortality and permanent complications (7. 8% vs. 4. 2% ).Conclusions. MDS and GDC are all materials for embolization of intracranial aneurysms. MDS is less expensive, but more difficult to control and of propensity to complications while GDC is more compliant, easier to be used, safer, and have many alternative types for use as well as more extensive indications.

EXPERIENCE OF MINIMALLY INVASIVE TREATMENT IN 520 PATIENTS WITH INTRACR ANIALANEURYSMS

Objective.To summarize the experience of minim ally invasive treatment in 520patie nts with intracranial aneurysms on a retrospective study.Methods.The measures used in the treatment of520patients were reviewed in terms o f timing of surgery,induced-hypotensive anesthesia,b rain protection combined with temporal occlusion of the feeding artery,exter-nal drainage of CSF,dynamic monitoring of intracranial pressure,blood flow velocity,serum osmolality and CT scanning,anti-vasospasm therapy a s well as selected interventional en dovascular embolization of aneurysms.Results.Of the 520patients,485were treated with either direct clipping or endov ascular embolization and35patients were treated non-surgic ally.In 449patients undergoing dir ect clipping and 36undergoing endov ascu-lar embolization,intraoperative r upture of aneurysm occurred in 27(6.0%)and 0%,respectively.Death oc-curred in 13(2.6%),hemiplegia in 8(1.6%),and vegetative state in 2(0.4%).The operative mortality of direct clipping was 3.8%in 210patie nts before 1990and 1.8%in 275patien ts after 1990(36patients undergo-ing endovascular embolization,the operative mortality was 0%).Conclusion.The outcome of patients with intracranial aneurysms can be markedly impr oved and the opera-tive mortality can be lowered by mini mally invasive treatment.

Cerebrospinal fluid and plasma propofol concentration during total intravenous anaesthesia of patients undergoing elective intracranial tumor removal

Objective： The aim of this paper is to compare the propofol concentration in plasma and cerebrospinal fluid （CSF） in patients scheduled for intracranial tumor removal and anaesthetized using propofol as part of a total intravenous anaesthesia technique. Methods： Twenty-seven patients （ASA Ⅰ-Ⅱ） scheduled for elective intracranial tumor removal were studied. Anesthesia was induced with 2 mg/kg propofol for 5 min and infused at 10 mg/（kg·h） for 5 min and then stopped. CSF and arterial blood were collected simultaneously before infusion of propofol and at different time points after infusion ofpropofol according to bispectral index （BIS） values. Concentrations of propofol in plasma and CSF were measured by HPLC with fluorescence detection. The correlation coefficient and regression equation between plasma and CSF concentration of propofol were worked out by linear simple regression. Results： The propofol CSF concentration that we measured was 1.46% of the plasma concentration. The coefficient of relation between plasma and CSF concentration was 76.7%. Conclusions： The propofol CSF concentration was positively correlated with and much lower than the plasma concentration. Discrepancies may result from high plasma protein binding of propofol, intracranial pathology and sampling volume.

Three-dimensional CT angiography and surgical correlation in the evaluation of intracranial aneurysms

OBJECTIVE: To evaluate the diagnostic accuracy of three-dimensional CT angiography in the surgical treatment of intracranial aneurysms. METHODS: Twenty-four patients suspected of intracranial aneurysms underwent routine catheter four-vessel angiography, three dimensional CT angiography (3D-CTA), magnetic resonance angiography (MRA) or conventional digital subtraction angiography (DSA). RESULTS: A total of 28 aneurysms were detected by CT angiography in this study. Twenty-one patients each had a single aneurysm, two patients each had two aneurysms, and one had three aneurysms. The shapes of aneurysms revealed by 3D-CTA were round in 20 lesions, elliptical in 5, and 1 obulated in 3. Of the 24 lesions which were completely disclosed during surgery, the shapes correlated well with the 3D-CT angiograms. The mean diameter of the aneurysmal neck was 5.9 mm in 3D-CTA images, with the smallest being 1.6 mm and the largest 13.7 mm. The size was very close to the actual size measured at surgery (P

Experimental study on transient flow patterns in simplified saccular intracranial aneurysm models using particle image velocimetry

The hemodynamics of intracranial aneurysm(IA)comprises complex transient flow patterns that affect its growth and rupture.Owing to the combined effects of geometrical factors and pulsatile flow conditions,the transient flow patterns in the IA are still unclear.The purpose of this work is to reveal the effect of the aspect ratio(AR,sac height/neck width)on the evolution of the internal flow patterns and the hemodynamics of the IA.We proposed an easy method to fabricate three simplified elastic IA models and measured the transient flow characteristics by using particle image velocimetry(PIV).Transient vortex structures in the IA modes during a cardiac cycle were systemically measured and many new flow phenomena were found,including the vortex morphology(size,structure,and core location),a high-speed jet,wall compliance effects,and three flow modes during retrograde flow phase.The results show that the AR of the IA affects the transient flow patterns as well as the wall shear stress(WSS)in complex ways.The results could deepen our understanding of the transient flow behaviors in IA and guide related clinical studies.