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目的通过对120例烟雾病手术患者观察,探讨术中脑肿胀的原因及紧急处理对策。方法对10年来120例烟雾病手术患者进行回顾性分析,其中20例患者术中打开硬脑膜后突然出现脑组织肿胀,随后改变手术方法 ,利用预先分离好的颞浅动脉给予脑-硬脑膜-动脉-肌肉血管融合术(EDAMS),术后用logistic回归对脑肿胀原因进行分析。结果对两组病例临床资料进行分析比较,分析术中脑肿胀与术前颅内压、PCO2、PO2、血压、脑内血肿并周围水肿的相关性,logistic回归分析显示,术前颅内压、PCO2、PO2、脑内血肿并周围水肿是与术中脑肿胀相关的最重要因素,而血压与术中脑肿胀不相关。结论烟雾病术前有必要行腰椎穿刺脑脊液压力测定,血气分析及头颅CT检查,预测术中脑肿胀,术中机械通气应温和,以避免PCO2、PO2剧烈变化。
Objective To observe the causes of intraoperative brain swelling and emergency treatment measures by observing 120 patients with moyamoya disease. Methods A retrospective analysis was performed on 120 patients with moyamoya disease during the past 10 years. Twenty patients underwent surgery to open the dura after operation, then the operation method was changed. The superficial temporal artery was used to give the brain - dura - Arterial-muscular vascular fusion (EDAMS), postoperative logistic regression analysis of brain swelling. Results The clinical data of two groups were analyzed and compared to analyze the relationship between intraoperative brain swelling and intracranial pressure before surgery, PCO2, PO2, blood pressure, intracerebral hematoma and peripheral edema. Logistic regression analysis showed that preoperative intracranial pressure, PCO2, PO2, intracerebral hematoma and peripheral edema were the most important factors associated with intraoperative brain swelling, whereas blood pressure was not correlated with intraoperative brain swelling. Conclusions It is necessary to measure lumbar puncture cerebrospinal fluid pressure (CSF), blood gas analysis and cranial CT examination before operation to predict intraoperative brain swelling and moderate mechanical ventilation during operation to avoid the drastic changes of PCO2 and PO2.