赵明媚 张晓鹏 刘 娜 陈瑶刚



显微手术治疗颅内破裂动脉瘤后脑血管痉挛（CVS）发生的影响因素

赵明媚 张晓鹏 刘 娜 陈瑶刚

【摘要】目的 研究分析显微手术治疗颅内破裂动脉瘤后脑血管痉挛（CVS）发生的影响因素。方法 回顾性分析本院2014年11月～2016年1月收治并采取显微手术治疗的颅内破裂动脉瘤患者51例临床资料。结果 通过统计分析发现，A组高龄患者比例、Fisher分级Ⅱ级以上者，以及SAH 3周内行手术且术前SAH次数2次以上患者血管痉挛发生率高于B组，差异有统计学意义（P＜0.05）。结论 显微手术治疗颅内动脉瘤后脑血管痉挛的因素复杂，需结合患者病情实际状态，选择恰当合理的治疗时机，通过良好的显微手术技巧降低脑血管痉挛发生率。

【关键词】显微手术；颅内破裂动脉瘤；脑血管痉挛；因素

Objective To study the influencing factors of the occurrence of cerebral vasospasm（CVS）after microsurgical treatment of intracranial ruptured aneurysms. Methods The clinical data of 51 patients with ruptured intracranial aneurysms treated by microsurgery in our hospital from November 2014 to January 2016 were analyzed retrospectively. Results Through statistical analysis found that the proportion of patients of elderly patients in the group A，fisher grade II level and above who，as well as SAH 3 week underwent surgery and preoperative SAH times 2 times more than patients with vasospasm occurred was significantly higher than that in group B，the difference was statistically significant（P＜0.05）. Conclusion Factors of Microsurgical treatment of intracranial artery aneurysm cerebral vasospasm are complex. Combined with the actual status of the patient's condition，to select the appropriate timing of treatment，through good microsurgical techniques can reduce cerebral vasospasm incidence. Microsurgery，intracranial ruptured aneurysm，cerebral vasospasm，factors

【Key words】 Microsurgery，Ruptured intracranial aneurysm，Cerebral vasospasm，Factors

脑血管痉挛（Cerebral vasospasm，CVS）主要是指颈内动脉或者是椎基底动脉因动脉硬化斑块的存在而导致血管腔明显变窄，血流通过病变部位时形成涡流且涡流加速时因压力过大对血管壁造成强烈刺激所致的血管痉挛。脑血管痉挛作为颅内动脉瘤手术后期较为严重的并发症之一，尤其对于部分采取显微手术方式治疗的颅内破裂动脉瘤患者有可能严重影响其预后恢复，同时CVS也能够导致继发性延迟性缺血性神经功能障碍，造成患者致残致死［1-3］。对此，清晰明辨颅内破裂动脉瘤术后诱发脑血管痉挛相关影响因素，为患者后期预防及预后处理产生积极作用。本文回顾本院2014年11月～2016年1月收治并采取显微手术治疗的颅内破裂动脉瘤患者51例临床资料，分组探讨脑血管痉挛（CVS）发生的影响因素，现报告如下。……