早期顯微手術治療前循環破裂腦動脈瘤68例臨床分析

[摘要] 目的 研究前循環破裂腦動脈瘤的早期顯微手術及腦血管痙攣的綜合防治。方法 整群選擇2014年2月—2016年2月醫院收治的前循環破裂的腦動脈瘤患者68例，術前均急診行DSA或CTA檢查明確診斷，后交通動脈瘤36例，前交通動脈瘤12例，大腦中動脈瘤7例，大腦前動脈瘤4例，頸內動脈其它部位動脈瘤9例。所有患者均于發病后72小時內采用顯微手術的方法進行治療，術中顯微解剖分離動脈瘤載瘤動脈及瘤頸后夾閉，清除血腫及沖洗釋放血性腦脊液，局部應用罌粟堿棉片貼敷，術后使用法舒地爾、尼莫地平等藥物對腦血管痙攣進行預防。記錄患者的動脈瘤成功夾閉率，病人功能恢復情況，同時記錄患者的治療效果。結果 動脈瘤頸成功夾閉率為88.24%（60/68），未能夾閉瘤頸8例：分別予動脈瘤孤立2例；載瘤動脈夾閉1例，動脈瘤包裹加固4例，血管塑形重建1例。改良Rankin量表評分0分17例、1分20例、2分17例、3分10例、4分2例、5分1例、6分1例；術后并發嚴重腦血管痙攣及腦梗塞1例，并發腦積水3例；隨訪6個月～2.1年，平均（11.3±5.6）個月，無動脈瘤復發病例，死亡1例。結論 早期顯微手術治療前循環破裂腦動脈瘤，能夠取得理想的治療效果，術中盡量徹底清除血凝塊，釋放血性腦脊液，局部應用罌粟堿，術后使用法舒地爾、尼莫地平等藥物，能夠有效防治腦血管痙攣的癥狀發生。

[關鍵詞] 腦動脈瘤；顯微手術治療；腦血管痙攣；綜合防治

[中圖分類號] R5 [文獻標識碼] A [文章編號] 1674-0742（2016）12（c）-0053-03

[Abstract] Objective To study the early microsurgery for ruptured cerebral aneurysms in anterior circulation and the comprehensive prevention and treatment of cerebral vasospasm. Methods Group selection from February 2014 to February 2016 admitted to the hospital in patients with cerebral aneurysms ruptured anterior circulation in 68 cases， preoperative emergency DSA or CTA diagnosis， posterior communicating artery aneurysm in 36 cases， 12 cases of anterior communicating artery aneurysms， 7 middle cerebral artery aneurysms， 4 cases of anterior cerebral artery aneurysms， 9 cases of internal carotid artery other parts of the aneurysm. Methods All patients within 72 hours of onset were treated by microsurgery， microdissection from aneurysm of the parent artery and aneurysm neck after intraoperative clipping， hematoma and flushing release bloody CSF， local application of papaverine cotton sticking， postoperative use of fasudil and nimodipine on cerebral vascular spasm to prevent. Record the success rate of aneurysm clipping， patients' functional recovery， and record the patient's treatment effect. Results The aneurysm neck clipping success rate was 88.24%（60/68）， failed to clipping of aneurysm in 8 cases： 2 cases were treated with isolated aneurysm； aneurysm clipping in 1 cases， 4 cases of aneurysm wrapped by vascular remodeling and reconstruction in 1 cases. The modified Rankin scale score of 0 points in 17 cases， 1 points were 20 cases， 2 points in 17 cases， 3 points were 10 cases， 4 points in 2 cases， 5 points were 1 cases and 6 points in 1 cases of severe cerebral vascular spasm； complicated with cerebral infarction and 1 cases of postoperative hydrocephalus， 3 cases were followed up for 6 months to； 2.1 years， （11.3± 5.6） months， no recurrence of aneurysm， 1 cases of death. Conclusion Early microsurgery for ruptured anterior circulation cerebral aneurysms， can obtain ideal curative effect， intraoperative to completely remove blood clots， release the bloody cerebrospinal fluid， local application of papaverine， fasudil and nimodipine after operation， can effectively prevent and control the occurrence of cerebral vascular spasm symptoms.

[Key words] Cerebral aneurysm；Microsurgical treatment；Cerebral vasospasm； Comprehensive prevention and treatment

腦動脈瘤是一種較為嚴重的神經外科疾病，是由于腦動脈內腔局限性異常擴大，導致動脈壁產生瘤狀突出。……