动脉瘤术后血管痉挛的综合治疗(附284例报告)

目的总结动脉瘤手术后血管痉挛及延迟性缺血性神经功能障碍(DIND)的防治经验。方法回顾性分析284例接受颅内动脉瘤夹闭术病人的临床资料,对颅多普勒超声(TCD)的结果与DIND的发生情况进行统计分析。结果137例病人手术后发生血管痉挛,79例发生DIND。TCD所示血流速度与DIND的发生有密切的相关关系。经治疗,62例DIND病人(78.5%)症状消失。病死率2.5%。结论血管痉挛是导致DIND的主要因素,个体化的综合治疗能明显提高疗效。

Comprehensive management of the postoperative vasospasm of intracranial aneurysms:report of 284 cases

Objective To summarize the experience of treating postoperative cerebral vasospasm and related delayed ischemic neurological deficit (DIND) of intracranial aneurysm. Methods 284 patients undergoing aneurysm clipping were studied retrospectively, including medical history, CT, TCD, occurrence of DIND and the protocol of treatment. Moreover, the relationship between the results of TCD and the occurrence of DIND was analyzed statistically. Results 137 cases presented vasospasm postoperatively, and DIND occurred in 79 patients. The statistical analysis showed that there was a direct correlation between the result of TCD and the manifestation of DIND. After treatment the symptoms of 62 patients (78.5%) with DIND disappeared. The total fatality rate of the group is 2.5%. Conclusion The vasospasm is the main cause of DIND; individual and comprehensive management will improve the prognosis.