颅内动脉瘤合并脑血管痉挛栓塞术后的观察与护理

目的:探讨颅内动脉瘤合并脑血管痉挛栓塞术后观察与护理的重要性。方法:本组36例颅内动脉合并脏血管痉挛患者入院72h内在全麻下行颅内动脉瘤栓塞术。术前、术中常规罂粟硷30mg/10ml持续静脉内泵入,术后持续泵入3d,给予尼莫通抗血管痉挛。术后第2天开始实施三高疗法,术后常规腰大池引流,放出血性脑脊液。结果:本组行颅内动脉瘤栓塞术后,32例恢复良好(可恢复工作,无明显神经系统功能障碍),2例持续昏迷自动出院;2例中度致残(轻度神经系统功能障碍,但生活能自理)。结论:利用护理手段干预4方面中的可控因素,如平均动脉压、颅内压、中心静脉压、血流速度(血液稀释度),使其控制在预设定目标范围内可保证脑的有效灌注压,预防CVS的发生。

Observation and nursing after endovascular embolization of intracranial aneurysm combining with cerebral vascular angiospasm

Objective:To discuss the importance of nursing after intracranial aneurysm endovascular embolization with cerebral vasospasm.Methods:Thirty-six patients suffered from intracranial aneurysm with cerebral vasospasm were treated by endovascular embolization under general anesthesia within 72 hours after hospitalization.Papaverine was pumped continuously(30mg/10ml) pre-.intra-and after-operation in three days.Nimodipine was injected at the same time."3 high" therapy was undergone in second day after embolization.Results:Thirty-two cases were completely recovered.Two cases coma persistently and two cases midrange mutilation.Conclusion:Cranial perfusion pressure can be maintained efficiently through intervene four aspects:MABP(mean arterial blood pressure),ICP(intracranial pressure),CVP(central venous pressure),and BFR(blood flow rate) to control them in reasonable scope.Thus cerebral vasospasm can be prevented.