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目的 对比观察血管内栓塞和开颅夹闭治疗颅内动脉瘤对病人术中颅内压、脑氧和脑糖代谢的影响。方法 选择Hunt分级为Ⅰ～Ⅲ级的脑动脉瘤择期手术 4 4例 ,按治疗方法分为电解可脱弹簧圈 (GDC)栓塞 (Ⅰ组 )和开颅脑动脉瘤夹闭 (Ⅱ组 ) ,各 2 2例。分别观察麻醉后手术前 (T0 )、脑动脉瘤夹闭前 (GDC栓塞前 ,T1)和夹闭后 10min(GDC栓塞后 ,T2 )等时相脑脊液压 (CSFP)、动脉瘤跨壁压 (TMP)和脑氧、脑糖代谢等指标及术毕麻醉恢复情况。结果 Ⅰ组 :与T0 比较 ,T1和T2 的颈内静脉球部血氧饱和度 (SjvO2 )明显增加 ,脑氧摄取率 (ERO2 )减少 ,差异具有显著性 (P <0 0 5 ) ,脑动静脉血糖差 [D(a jv)BG]、乳酸浓度差 [D(a jv)BL]和血氧差 [D(a jv)O2 ]等指标无明显变化 (P >0 0 5 )。Ⅱ组 :与T0 比较 ,T1和T2 的D(a jv)BL和D(a jv)BG增加 ,D(a jv)O2 减少 ,差异具有显著性意义 (P <0 0 5 ) ,SjvO2 和ERO2 差异无显著性意义 (P >0 0 5 )。Ⅰ组 :与T0 比较 ,T1和T2 的CSFP和TMP无明显变化 (P >0 0 5 )。Ⅱ组 :与T0 比较 ,T1和T2 的CSFP降低 ,TMP增加 ,差异具有显著性 (P <0 0 5 )。与Ⅰ组比较 ,Ⅱ组T1和T2 相应时相的CSFP降低 ,TMP增加 ,差异具有显著性意义 (P <0 0 5 )。与Ⅱ组比较 ,Ⅰ组术毕自主呼吸恢复时
Objective To compare the effects of intravascular embolization and craniotomy clipping on intracranial pressure, cerebral oxygen and cerebral glucose metabolism in patients with intracranial aneurysm. Methods Forty four patients with Hunt grade Ⅰ ~ Ⅲ were enrolled in this study. Embolization was performed according to the method of treatment (group Ⅰ) and craniotomy (group Ⅱ) Each 2 2 cases. The changes of isokinetic blood pressure (CSFP), aneurysm transmural pressure (before anesthesia), before occlusion of cerebral aneurysm (T1 before GDC embolization, 10 min after occlusion (T2 after GDC embolization) TMP) and cerebral oxygen, brain glucose metabolism and other indicators and recovery after anesthesia. Results Compared with T0, the SjvO2 of the internal jugular vein increased significantly at T1 and T2, the ERO2 decreased at T1 and T2, the difference was significant (P <0.05) There was no significant change in the indexes of venous blood glucose (D (a jv) BG], lactate concentration difference (D (ajv) BL) and blood oxygen difference (D jjO2) In group Ⅱ, D (a jv) BL and D (a jv) BG increased and D (a jv) O2 decreased at T1 and T2, with significant difference (P <0.05), SjvO2 and ERO2 There was no significant difference (P> 0.05). Group Ⅰ: Compared with T0, there was no significant change of CSFP and TMP in T1 and T2 (P> 0.05). Group Ⅱ: Compared with T0, the CSFP of T1 and T2 decreased and TMP increased, the difference was significant (P <0.05). Compared with group Ⅰ, the CSFP and the TMP in the corresponding phase of T1 and T2 in group Ⅱ were significantly decreased (P <0.05). Compared with group Ⅱ, group Ⅰ at the end of resumption of spontaneous breathing