早期超选择动脉灌注及血管成形术治疗动脉瘤夹闭后脑血管痉挛

目的 研究早期超选择动脉灌注罂粟碱及血管成形术治疗颅内动脉瘤夹闭术后症状性脑血管痉挛(CVS)的疗效.方法 76例CVS患者均在临床症状明显恶化后8 h内接受动脉内0.3%的罂粟碱灌注,对12例近端、局限性CVS采用血管成形术治疗.采用经颅多普勒超声(TCD)评估治疗前、后痉挛动脉平均血流速度变化,采用Bartel指数对治疗前、后临床状况进行评估.结果 TCD显示治疗前、后MCA平均血流速度由(149±4)cm/s降至(108±5)cm/s(t=38.31,P＜0.05),治疗前Bartel指数为29±6,治疗后为49±7(t=32.12,P＜0.05),无死亡.术后随访3个月按Jennett方法评定,良好61例(80.26%),较差12例(15.79%),死亡3例(3.95%).结论 早期超选择动脉灌注罂粟碱及血管成形术是治疗症状性脑血管痉挛的有效方法.

Ultraselective intra-arterial perfusion of papaverine and transluminal baioon angioplasty in early stage in symptomatic cerebral vasospasm after aneurysm clipping

Objective To study the efficacy of uhraselective intra-arterial infusion of papaverine and transluminal baloon angioplasty(TBA)in early stage in symptomatic cerebral vasospasm after aneurysm clipping.Methods 76 patients whose intracranial aneurysms were clipped,were treated within 8 hours after their clinical symptoms had deteriorated remarkably,and 0.3%(w/v)papaverine perfusion was performed.TBA was used to eliminate the stenosis in extracranial arterial in 12 cases.The changes of mean blood flow velocities(mBFVs)on the severe side of the middle cerebral artery were measured by transcranial Doppler sonography(TCD),and the clinical efficacy was evaluated by Barthel index before and after treatment.Results TCD showed that mBFVs in the middle cerebral artery decreased from(149±4)cm/s to(108±5)cm/s(t=38.31,P＜0.05).The consciousness,limb movement and language function improved significantly in 76 patients after the procedure,and their Barthel index had increased significantly(29±6 vs 49±7,t=32.12,P＜0.05).Three months after treatment all patients were recovered,including better in 61 cases(80.26%),poorer in 12 cases(15.79%)and death in 3 cases(3.95%).Conclusion Ultraselective intra-arterial infusion of papavenne and transluminal baloon angioplasty in early stage for symptomatic cerebral vasospasm after aneurysm clipping is an effective method.