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目的探讨颅内动脉瘤破裂出血并脑疝患者急诊手术的可行性。方法 5例颅内动脉瘤破裂出血并脑疝形成患者入院经CT检查后直接急诊开颅探查,术中先清除部分颅内血肿,降低颅内压,后行动脉瘤探查并夹闭;对探查过程中再次破裂出血者及时控制出血并夹闭动脉瘤。术后3月按GOS分级标准对患者的预后进行评价。结果术中发现前交通动脉瘤2例,后交通动脉瘤2例,大脑中动脉瘤1例。按GOS评价预后,恢复良好2例,中残1例,植物生存1例,死亡1例。结论动脉瘤破裂出血并脑疝者病情危重,需要急诊手术;只要术前准备充分,即使在探查中动脉瘤再次出血,也能很好地控制出血并夹闭动脉瘤。
Objective To investigate the feasibility of emergency surgery for patients with intracranial aneurysm rupture and cerebral hernia. Methods 5 cases of intracranial aneurysm rupture and hernia formation were admitted to the hospital after CT examination of direct emergency craniotomy to remove part of the intracranial hematoma, reduce intracranial pressure, posterior aneurysm exploration and clipping; exploration Bleeding again in the process of bleeding control and timely closure of aneurysms. The prognosis of patients was evaluated by GOS grading standards after March. Results There were 2 cases of anterior communicating aneurysm, 2 cases of posterior communicating aneurysm and 1 case of middle cerebral artery aneurysm. According to the prognosis of GOS, good recovery in 2 cases, 1 case of residual, 1 case of plant survival, 1 case of death. Conclusions Aneurysm rupture and brain hernia are critically ill and require emergency surgery. As long as the preoperative preparation is adequate, hemorrhage and occlusion of the aneurysm can be well controlled even if the aneurysm rebleeds during exploration.