动脉瘤夹闭术对蛛网膜下腔积血量的影响-南方医科大学学报.PDF

J South Med Univ, 2013, 33(7): 1041-1044 doi 10.3969/j.issn. 1673-4254.2013.07.21 ·1041 · 临床研究 动脉瘤夹闭术对蛛网膜下腔积血量的影响动脉瘤夹闭术对蛛网膜下腔积血量的影响 刘 飞，袁 文，廖达光，张天一，王知非 中南大学湘雅三医院神经外科，湖南 长沙 410013 摘要：目的研究动脉瘤夹闭术（并清除部分脑池内的淤血块）对不同Fisher 分级患者的蛛网膜下腔积血量及脑血管痉挛程度的 影响。方法 SAH 患者依Fisher Ⅰ、Ⅱ、Ⅲ级分成3 组，每组分为试验亚组和对照亚组进行比较；另将同期未破裂动脉瘤行夹闭 术的患者做为未破裂手术组与Fisher Ⅰ组对照亚组比较。所有患者均在发病后第3、7、13天取脑脊液检测氧合血红蛋白 （OxyHb）浓度和TCD 检测大脑中动脉（MCA）血流速度。结果 （1）未破裂手术组与Fisher I 组对照亚组比较：未破裂手术组的 OxyHb 浓度在第3 天显著增高，MCA 血流速度在第3、7 显著性增高（P0.05）；（2）试验组与对照组比较：OxyHb 浓度在Fisher Ⅰ、Ⅱ级的第3 天显著增高（P0.05），但在Fisher Ⅲ级的第7、13天显著降低（P0. 05）；MCA 血流速度在Fisher I 级第3、7 天和 Fisher Ⅱ级的第7 天显著增高（P0.05），但Fisher Ⅲ级第7、13天显著降低（P0.05）；（3）MCA 血流速度与脑脊液中OxyHb 浓度 呈正相关（P0.05）。结论 对于Fishe Ⅰ、Ⅱ级SAH动脉瘤患者，术后反而积血增多并加重了脑血管痉挛；对于Fisher Ⅲ级SAH 动脉瘤患者，术后积血减少并部分缓解脑血管痉挛，有积极的临床意义。 关键词：蛛网膜下腔出血；蛛网膜下腔积血量；脑血管痉挛；动脉瘤夹闭术 Effect of aneurysm clipping on hemorrhage volume in the subarachnoid space LIU Fei, YUAN Wen, LIAO Daguang, ZHANG Tianyi, WANG Zhifei Department of Neurosurgery, Third Xiangya Hospital of Central South University, Changsha 410013, China Abstract: Objective To evaluate the effect of aneurysm clipping and partial blood clot removal in the subarachnoid space on hemorrhage volume in the subarachnoid space and cerebral vasospasm in patients with different Fisher grades. Methods Patients with subarachnoid space hemorrhage (SAH) of Fisher Grades I, II, and III were subdivided into control and treatment groups for comparative studies. The patients with unruptured intracranial aneurysms (UIAs) undergoing aneurysm clipping were also compared with Fisher grade I control subgroup. OxyHb levels in the cerebrospinal fluid and cerebral blood flow volume (CBFV) of the middle cerebral artery (MCA) were measured on days 3, 7, and 13 day after SAH. Results The patients with UIAs and Fisher Grade I contro