早期顯微手術(shù)治療前循環(huán)破裂腦動(dòng)脈瘤68例臨床分析

[摘要] 目的 研究前循環(huán)破裂腦動(dòng)脈瘤的早期顯微手術(shù)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(yī)院收治的前循環(huán)破裂的腦動(dòng)脈瘤患者68例，術(shù)前均急診行DSA或CTA檢查明確診斷，后交通動(dòng)脈瘤36例，前交通動(dòng)脈瘤12例，大腦中動(dòng)脈瘤7例，大腦前動(dòng)脈瘤4例，頸內(nèi)動(dòng)脈其它部位動(dòng)脈瘤9例。所有患者均于發(fā)病后72小時(shí)內(nèi)采用顯微手術(shù)的方法進(jìn)行治療，術(shù)中顯微解剖分離動(dòng)脈瘤載瘤動(dòng)脈及瘤頸后夾閉，清除血腫及沖洗釋放血性腦脊液，局部應(yīng)用罌粟堿棉片貼敷，術(shù)后使用法舒地爾、尼莫地平等藥物對(duì)腦血管痙攣進(jìn)行預(yù)防。記錄患者的動(dòng)脈瘤成功夾閉率，病人功能恢復(fù)情況，同時(shí)記錄患者的治療效果。結(jié)果 動(dòng)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(dòng)脈瘤孤立2例；載瘤動(dòng)脈夾閉1例，動(dòng)脈瘤包裹加固4例，血管塑形重建1例。改良Rankin量表評(píng)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(shù)后并發(fā)嚴(yán)重腦血管痙攣及腦梗塞1例，并發(fā)腦積水3例；隨訪6個(gè)月～2.1年，平均（11.3±5.6）個(gè)月，無動(dòng)脈瘤復(fù)發(fā)病例，死亡1例。結(jié)論 早期顯微手術(shù)治療前循環(huán)破裂腦動(dòng)脈瘤，能夠取得理想的治療效果，術(shù)中盡量徹底清除血凝塊，釋放血性腦脊液，局部應(yīng)用罌粟堿，術(shù)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(fā)生。

[關(guān)鍵詞] 腦動(dòng)脈瘤；顯微手術(shù)治療；腦血管痙攣；綜合防治

[中圖分類號(hào)] R5 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 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(dòng)脈瘤是一種較為嚴(yán)重的神經(jīng)外科疾病，是由于腦動(dòng)脈內(nèi)腔局限性異常擴(kuò)大，導(dǎo)致動(dòng)脈壁產(chǎn)生瘤狀突出。……