显微手术夹闭破裂颅内动脉瘤后脑血管痉挛的预防与治疗

目的总结显微手术夹闭破裂颅内动脉瘤后脑血管痉挛的防治经验及体会。方法48例破裂颅内动脉瘤患者，行颅内动脉瘤夹闭术，术中采用罂粟碱溶液冲洗，术后采取腰大池持续引流、尼莫地平经深静脉持续泵入、适度的3H治疗等综合措施。结果48例患者，术后6例（12．5％）发生脑血管痉挛；术后随访3个月，根据GOS评分，恢复良好34例（70．8％），轻残11例（22．9％），重残3例（6．3％），无植物生存和死亡病例。结论破裂颅内动脉瘤显微夹闭术中、术后，积极预防和治疗脑血管痉挛可显著降低患者的致残率和病死率。

The prevention and treatment of cerebral vasospasm in patients with ruptured intracranial aneurysm undergoing aneurysm clipping

Objective To summarize the experience of treating postoperative cerebral vasospasm of ruptured intracranial aneurysm. Methods 48 patients with ruptured intracranial aneurysm undergoing aneurysm clipping were treated comprehensively by papaverine solution lavage in surgical field during intraeranial aneurysm surgery, lumbar continued drainage of cerebrospinal fluid, nimodipine infusion continuously and 3H therapy after operation. Results 6 cases（12. 5%） presented vasospasm postoperatively. All the patients were followed up for 3 months. Glasgow outcome scale （GOS） was applied to the research . Among the 48 patients with ruptured intracranial aneurysm, 34 patients （70.8%） got 5 points , 11 patients （22.9%） got 4 points and 3 patients got 3 points （6.3%）. None was in plant state or died. Conclusion During and after the aneurysm clipping operation, the disabled and death rates may be decreased by comprehensive management in prevention and therapy of cerebral vasospasm in patients with ruptured intracranial aneurysm.