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目的探讨手术中颅内动脉瘤破裂的处理及预防。方法采用气管内插管全麻开颅手术 ,降血压至 70～ 90 mm Hg( 9.3～12 .0 k Pa) ,显露并临时阻断载瘤动脉近端 ,2 8例夹闭动脉瘤。 3例结扎载瘤动脉。 2例行可脱性球囊闭塞载瘤动脉近端 ,其中 1例行颞浅动脉 -大脑中动脉吻合术。 2 8例有脑肿胀者去骨瓣减压。结果按 Jennett方法评定效果 ,良好 (包括中残 ) 2 2例 ( 66.67% ) ,其中 16例数字减影血管造影术 ( DSA)全脑血管造影提示夹闭动脉瘤效果满意 ,较差 (重残或植物状态 ) 6例 ( 18.18% ) ,死亡 5例 ( 15 .15 % )。结论手术中颅内动脉瘤破裂可发生在动脉瘤显露前、显露期间及动脉瘤夹闭过程中 ,采用显微手术、控制性低血压 ,尽早显露并控制载瘤动脉近端 ,可减少术中破裂出血 ,保证手术成功。
Objective To investigate the treatment and prevention of intracranial aneurysm rupture during surgery. Methods The endotracheal intubation and general anesthesia craniotomy was performed to lower the blood pressure to 70-90 mm Hg (9.3-12.0 kPa). The proximal part of the parent artery was occluded and the aneurysm was occluded in 28 cases. 3 cases ligation of the parent artery. 2 cases of detachable balloon occlusion of the proximal part of the parent artery, including 1 case of superficial temporal artery - middle cerebral artery anastomosis. Twenty-eight patients with brain swelling decompressive craniectomy. Results The results were evaluated by Jennett method. Twenty-two patients (66.67%) were good (including middle-residual). Among them, 16 DSA angiography showed satisfactory results of clipping aneurysm, poor Or plant status) in 6 cases (18.18%) and death in 5 cases (15.15%). Conclusions The ruptured intracranial aneurysm during surgery may occur during the aneurysm before and during the exposure, and during the aneurysm occlusion, microsurgery and controlled hypotension may be used to expose and control the proximal part of the parent artery to reduce the intraoperative Bleeding rupture, to ensure successful operation.