颅内动脉瘤介入治疗围手术期缺血并发症的病因分析与防治（附48例报告）

发布时间：2018-05-27 05:07

  本文选题：颅内动脉瘤 + 血管内治疗　； 参考：《郑州大学》2017年硕士论文

【摘要】：目的通过单中心颅内动脉瘤介入治疗围手术期缺血并发症的回顾性分析,总结介入治疗相关缺血并发症的发生原因并探索有效的防治方法。方法收集郑州大学第一附属医院神经介入科2011年1月至2015年3月共1106例动脉瘤栓塞病例资料,共48例患者术后出现神经功能损伤症状,对该48例患者临床影像学资料及随访结果进行分析,评估术中及术后缺血并发症发生原因并探索有效防治方法。结果本组48病例中男性17例,女性31例。年龄36~77岁,平均年龄57.1±9.5岁。48例患者动脉瘤直径范围为2.4~13.0mm,平均5.6±2.6mm。其中37例患者以动脉瘤性蛛网膜下腔出血为首发症状入院,入院时Hunt-Hess分级分别为Ⅰ级20例,Ⅱ级7例,Ⅲ级6例,Ⅳ级4例。48例病人手术均成功实施。经讨论分析48例缺血并发症临床及影像学资料,发生原因分别为血管痉挛(19例),脑动脉血栓形成(16例),脑动脉闭塞(6例),术中低血压(4例)以及脑水肿(3例)。并发症治疗措施包括强化抗凝、抗血小板聚集、抗痉挛、升压、扩容等药物治疗及血管内溶栓、机械开通治疗等措施。48例患者术后3月随访共34例(70.8%)患者m RS评分≤2,未遗留严重的后遗症,14例(29.2%)患者m RS2,预后不良。结论导致本组48例并发症产生原因有脑血管痉挛、脑动脉血栓形成、脑动脉闭塞、脑水肿及脑低灌注。根据患者不同症状及发病原因给与不同治疗策略及方法,包括脱水、抗凝、抗血小板聚集、抗痉挛、升压、扩容及血管内溶栓、机械开通等措施。针对颅内动脉瘤介入栓塞术缺血并发症需明确分析并发症类型以及发病机制才能有效预防缺血并发症的发生。
[Abstract]:Objective to summarize the causes of ischemic complications associated with interventional therapy of intracranial aneurysms and to explore effective methods to prevent and treat them by retrospective analysis of perioperative ischemic complications in patients with monocentric intracranial aneurysms. Methods from January 2011 to March 2015, 1106 patients with aneurysm embolism were collected from Department of Neurointervention, first affiliated Hospital of Zhengzhou University. The clinical imaging data and follow-up results of 48 patients were analyzed to evaluate the causes of ischemic complications during and after operation and to explore effective methods of prevention and treatment. Results there were 17 males and 31 females in 48 cases. The mean age was 57.1 卤9.5 years old. The diameter of aneurysms in 48 patients was 2.4 卤13.0mm, with an average of 5.6 卤2.6 mm.. Among them, 37 patients were admitted to hospital with aneurysm subarachnoid hemorrhage as the initial symptom. The Hunt-Hess grading was grade 鈪，

本文编号：1940554