夹闭术与栓塞治疗对颅内破裂动脉瘤病人局部脑氧饱和度的影响
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摘要
目的探讨开颅夹闭术及栓塞治疗对颅内破裂动脉瘤病人局部脑氧饱和度(rScO_2)的影响。方法回顾性分析2016年9月至2018年5月收治的45例颅内破裂动脉瘤的临床资料。开颅夹闭术治疗30例(夹闭组),栓塞治疗15例(栓塞组)。入院时、术后1、2、3、7 d采用近红外光谱技术监测rScO_2。结果夹闭组术后2、3 d rScO_2较术前明显降低(P<0.05);而栓塞组术后1、2、3、7 d rScO_2均无明显变化(P>0.05)。术后2、3 d,夹闭组rScO_2明显低于栓塞组(P<0.05),但术后7 d两组rScO_2无明显差异(P>0.05)。结论与栓塞治疗比较,开颅夹闭术对颅内破裂动脉瘤术后早期rScO_2有一定影响。
Objective To explore the regional cerebral oxygenation(rScO_2) in the patients with ruptured intracranial aneurysms(rICA) after the clipping and endovascular embolization. Methods Of 45 patients with rICA, 30 underwent microsurgical clipping and 15 endovascular embolization. The rScO_2 was determined by near infrared spectroscopy technology(NIRS) before and 1, 2, 3 and 7 days after the operation in all the patients. Results The level of rScO_2 was significantly lower in the clipping group than that in the embolization group 2 days after the operation(P<0.05). The levels of rScO_22 and 3 days after the operation were significantly lower than that before the operation in the clipping group(P<0.05), but there were insignificant differences in the levels of rScO_2 among 1, 2, 3 and7 days after the operation(P>0.05) and between 1 or 2 or 3 or 7 days after the operation and before the operation in the embolization group(P>0.05). Conclusions Compared with the embolization, the clipping has some bad effects on rScO_2 level early after the operation,but there was no significant effect of the clipping on rScO_2 late after the operation in the patients with r ICA.
Objective To explore the regional cerebral oxygenation(rScO_2) in the patients with ruptured intracranial aneurysms(rICA) after the clipping and endovascular embolization. Methods Of 45 patients with rICA, 30 underwent microsurgical clipping and 15 endovascular embolization. The rScO_2 was determined by near infrared spectroscopy technology(NIRS) before and 1, 2, 3 and 7 days after the operation in all the patients. Results The level of rScO_2 was significantly lower in the clipping group than that in the embolization group 2 days after the operation(P<0.05). The levels of rScO_22 and 3 days after the operation were significantly lower than that before the operation in the clipping group(P<0.05), but there were insignificant differences in the levels of rScO_2 among 1, 2, 3 and7 days after the operation(P>0.05) and between 1 or 2 or 3 or 7 days after the operation and before the operation in the embolization group(P>0.05). Conclusions Compared with the embolization, the clipping has some bad effects on rScO_2 level early after the operation,but there was no significant effect of the clipping on rScO_2 late after the operation in the patients with r ICA.
引文
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[2] Zulueta JL, Vida VL, Perisinotto E, et al. Role of intraoperative regional oxygen saturation using near infrared spectroscopy in the prediction of low output syndrome after pediatric heart surgery[J]. J Card Surg, 2013, 28(4):446-452.
[3] Yousef KM, Balzer JR, Crago EA, et al. Transcranial regional cerebral oxygen desaturation predicts delayed cerebral ischaemia and poor outcomes after subarachnoid haemorrhage:a correlational study[J]. Intensive Crit Care Nurs,2014, 30(6):346-352.
[4] Zaidat OO, Ionita CC, Hussain SI, et al. Impact of ruptured cerebral aneurysm coiling and clipping on the incidence of cerebral vasospasm and clinical outcome[J]. J Neuroimagging, 2009, 19(2):144-149.
[5] Find lay JM, Nisar J, Darsaut T. Cerebral vasospasm:a review[J]. Can J Neurol Sci, 2016, 43(1):15-32.
[6] Konczalla J, Schuss P, Platz J, et al. Clinical outcome and prognostic factors of patients with angiogram-negative and non-perimesencephalic subarachnoid hemorrhage:benign prognosis like perimesencephalic SAH or same risk as aneurysmal SAH[J]. Neurosurg Rev, 2015, 38(1):121-127.
[7] Ding D. Predicting the course of aneurysmal subarachnoid hemorrhage with biomarkers:molecular basis of delayed neurological deterioration[J]. J Neurol Sci, 2014, 345(1-2):274-275.