颅内动脉瘤介入治疗围术期缺血并发症病因分析与防治(附48例报告)

摘要

Objective To analyze the etiology of cerebral ischemic complications occurring in perioperative period of interventional therapy for intracranial aneurysms,and to discuss its prevention and treatment.Methods From January 2011 to March 2015,a total of 1106 patients with intracranial aneurysms underwent interventional therapy at the First Affiliated Hospital of Zhengzhou University,China.Among the 1106 patients,48 patients developed cerebral ischemic complications;their clinical data and the imaging materials were retrospectively analyzed.The factors associated with complications,the effective therapeutic scheme and the clinical preventive methods were discussed.Three months after the treatment,the recovery of neurological function was assessed with modified Rankin Scale (mRS).Results The causes of ischemic complications were,in order of decreasing frequency,cerebral vasospasm/unable elimination of microemboli (n=19),thrombus (n=16),impaired blood flow of adjacent perforating or distal vascular branches caused by embolization (n=6),intra-procedural hypotension (n=4) and cerebral edema (n=3).Combined treatments,including integrated anticoagulation,anti-platelet aggregation,anti-vasospasm,medication of elevating blood pressure,endovascular intervention,etc.were adopted.The patients were followed up for 3 months.Thirty-four patients (70.8％) obtained a mRS of ≤2 (no serious sequelae),and mRS＞2 (poor prognosis) was seen in 14 patients (29.2％).Conclusion The etiology of cerebral ischemia occurring during interventional treatment of intracranial aneurysms is complicated.It is necessary to take useful measures such as individualized anticoagulation,anti-platelet aggregation,anti-vasospasm,etc.during perioperative period of interventional therapy.The procedure-related complications can be effectively treated with interventional therapy and reliably prevented by careful and skilled surgical manipulation.%目的 分析颅内动脉瘤介入治疗围手术期缺血并发症病因与防治方法.方法 回顾2011年1月至2015年3月郑州大学第一附属医院1 106例颅内动脉瘤介入术中确诊的48例缺血并发症患者临床与影像学资料,分析缺血并发症相关因素、治疗方案及可能的预防方法,术后3个月采用改良Rankin量表(mRS)评分评价神经功能恢复状况.结果 48例缺血并发症发生原因依次为脑血管痉挛/微栓子清除障碍(19例)、血栓栓塞(16例)、栓塞治疗影响瘤囊或附近穿支或远端血流(6例)、术中低血压(4例)、脑水肿(3例),经强化抗凝、抗血小板聚集、抗痉挛、升压药物及血管内介入等综合治疗后3个月随访,34例(70.8％)mRS评分≤2(未遗留严重后遗症),14例(29.2％)＞2(预后不良).结论 颅内动脉瘤介入治疗时发生缺血的病因复杂,需要介入围术期个体化抗凝、抗血小板聚集、抗痉挛等管理.对手术操作相关并发症,可通过介入补救处理及提高技术水平有效预防.