同型半胱氨酸及胆红素对颅内动脉瘤夹闭后脑血管痉挛和预后的影响

发布时间：2018-04-04 09:32

本文选题：颅内动脉瘤　切入点：脑血管痉挛　出处：《吉林大学》2017年硕士论文

【摘要】：研究背景:颅内动脉瘤已成为威胁人类健康的重大疾病之一,其破裂出血后致残率和死亡率极高。近来来随着治疗方法和围手术期管理的进展,患者的致死致残率不断降低,但对于影响预后最关键的因素之一脑血管痉挛的机制仍不十分清楚,研究发现影响脑血管痉挛发生的主要因素有年龄、发病时的分级、二次出血、脑室内或脑内的血肿、急性脑积水、动脉瘤的大小和位置、白细胞计数增高、白介素-6的水平、心脏功能的异常以及吸烟史、高血压等,而同型半胱氨酸水平和胆红素水平作为近年来发现的影响脑血管病发展的两大因素,有少量报道同型半胱氨酸水平对脑血管痉挛和预后有影响,而胆红素的氧化产物是在体内外试验中均明确的可以导致脑血管痉挛发生的化学物质之一,但对于同型半胱氨酸和血清胆红素水平的变化对脑血管痉挛以及颅内动脉瘤开颅手术预后的影响仍缺乏足够的临床研究。目的:通过对围手术期同型半胱氨酸和血清胆红素水平变化的研究来探讨其对于动脉瘤性蛛网膜下腔出血患者行开颅手术围手术期脑血管痉挛和预后的影响,以期对临床治疗和围手术期管理有一定帮助。方法:选择2015年3月-2016年7月吉林大学第二医院住院治疗的176名动脉瘤性蛛网膜下腔出血行开颅夹闭术的患者,年龄范围为46-83岁,选择其围手术期的同型半胱氨酸水平、血清胆红素水平,比较不同同型半胱氨酸水平脑血管痉挛的发生率和预后情况,以及胆红素的变化曲线,并比较围手术期不同胆红素峰值下脑血管痉挛的发生率与预后情况,并与103名年龄范围为45-80岁的我院同期体检的患者血清同型半胱氨酸水平及胆红素水平进行比较,分析其差异性。结果:1.动脉瘤性蛛网膜下腔出血的患者平均血清同型半胱氨酸水平较正常人群高(P0.01)。2.血清同型半管氨酸水平与动脉瘤夹闭术后脑血管痉挛的发生率呈正相关(P0.05)。3.高同型半胱氨酸血症的患者开颅夹闭术预后较血清同型半胱氨酸水平正常的患者差(P0.05)。4.颅内动脉瘤夹闭术的患者围手术期血清胆红素水平呈抛物线状变化,在术后第1天左右(即发病第3-4天)达到峰值。5.围手术期血清胆红素峰值与脑血管痉挛的发生率呈正相关(P0.01)。6.围手术期血清胆红素水平峰值高的患者较峰值低的患者预后差(P0.05)。7.有颅内动脉瘤破裂出血病史的患者日常胆红素水平较同龄健康人群的胆红素水平低(P0.01)。8.同型半胱氨酸水平对颅内动脉瘤夹闭术围手术期血清胆红素峰值无明显影响(P0.05)。结论:1.高同型半胱氨酸水平及低血清胆红素水平是颅内动脉瘤发生的危险因素之一。2.高同型半胱氨酸血症是颅内动脉瘤开颅夹闭术后脑血管痉挛的危险因素之一。3.动脉瘤性蛛网膜下腔出血患者行开颅夹闭术围手术期胆红素水平呈抛物线状变化,其峰值约在手术后1-2天,即蛛网膜下腔出血发生后3-4天左右,且高血清胆红素水平可能是脑血管痉挛发生的危险因素之一,也可能是即将出现或已经出现脑血管痉挛的一个标志。4.高同型半胱氨酸水平和高围手术期胆红素水平是动脉瘤性蛛网膜下腔出血预后不良的危险因素之一。
[Abstract]:Background: intracranial aneurysm has become one of the major threats to human health. Its rupture after morbidity and high mortality rate. In recent years with the progress of treatment and perioperative management of the patients, the mortality rate decreased, but the mechanism of the factors affecting the prognosis of the key of cerebral vasospasm is still not very clear, study found that the main factors affecting cerebral vasospasm with age, disease classification, two hemorrhage, intraventricular or intracerebral hematoma, acute hydrocephalus, size and location of the aneurysm, white blood cell count increased, the level of interleukin -6, abnormalities of cardiac function and smoking history. Hypertension, two major factors influencing the development of cerebrovascular disease and homocysteine level and serum bilirubin level as found in recent years, there have been a few reports of homocysteine level have influence on the prognosis of cerebral vasospasm and spasm Ring, and the oxidation products of bilirubin in vivo test is clearly one of the chemicals can cause cerebral vasospasm, but changes in homocysteine and serum bilirubin levels on cerebral vasospasm and intracranial aneurysm craniotomy prognosis is still a lack of sufficient clinical studies. Objective: To study the perioperative changes of plasma homocysteine and serum bilirubin level operation period to explore its effect on the patients undergoing craniotomy during perioperative period and prognosis of cerebral vasospasm after aneurysmal subarachnoid hemorrhage, in order to have some help for clinical treatment and perioperative management. Methods: the craniotomy clipping in March 2015 hospitalized in July the second hospital of Jilin University during -2016 176 aneurysmal subarachnoid hemorrhage patients, the age range was 46-83, the perioperative period of homocysteine The level of serum bilirubin level, compare the different incidence and prognosis of homocysteine level in cerebral vasospasm, and bilirubin changes curve, incidence and prognosis of cerebral vasospasm and peri operation period under different bilirubin peak, compared to the same period in our hospital physical examination in patients with serum homocysteine levels and serum bilirubin level and with the 103 age range was 45-80, the difference is analyzed. Results: 1. patients with aneurysmal subarachnoid hemorrhage patients average serum homocysteine level is higher than that of normal subjects (P0.01).2. serum homocysteine level and amino acid tube aneurysm clipping of cerebral vasospasm incidence was positively correlated (P0.05).3. hyperhomocysteinemia in patients with neurosurgical clipping prognosis than the serum homocysteine level in patients with normal difference (P0.05).4. intracranial aneurysm surgery patients with hand The serum bilirubin level of patients was parabola, after first days (the onset of the first 3-4 days) and.5. reached the peak of perioperative serum bilirubin peak and cerebral vasospasm occurrence rate was positively correlated with.6. (P0.01) in the prognosis of patients with the peak serum bilirubin level in operative patients with high peak low difference (P0.05.7.) with intracranial aneurysm rupture bleeding in patients with a history of bilirubin level daily bilirubin level than the healthy population is low (P0.01).8. on homocysteine levels in intracranial aneurysm surgery perioperative serum bilirubin peak had no significant effect (P0.05). Conclusion: 1. high homocysteine levels and low serum bilirubin level is one of the risk factors for the occurrence of intracranial aneurysms.2. hyperhomocysteinemia is a risk factor for intracranial aneurysm cerebral vasospasm after clipping of aneurysmal subarachnoid.3. Hemorrhage underwent clipping of peri operative serum bilirubin level was parabola, its peak at about 1-2 days after surgery, the subarachnoid hemorrhage occurred after 3-4 days or so, and the high level of serum bilirubin may be one of the risk factors of cerebral vasospasm, can also be a sign of impending or.4. cerebral vasospasm occurred in high homocysteine levels and high bilirubin levels around operation period is one of the risk factors of aneurysmal subarachnoid hemorrhage prognosis.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743

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