[1]周 智.不同治疗方法对颅内动脉瘤病人血流动力学和能量代谢影响的对比分析[J].中国临床神经外科杂志,2017,(06):410-412.[doi:10.13798/j.issn.1009-153X.2017.06.015]
 ZHOU Zhi..Effects of therapeutic methods on cerebral hemodynamics and cerebral energy metabolism in patients with cerebral aneurysms: clipping vs. endovascular embolization[J].,2017,(06):410-412.[doi:10.13798/j.issn.1009-153X.2017.06.015]
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不同治疗方法对颅内动脉瘤病人血流动力学和能量代谢影响的对比分析()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2017年06期
页码:
410-412
栏目:
论著
出版日期:
2017-06-25

文章信息/Info

Title:
Effects of therapeutic methods on cerebral hemodynamics and cerebral energy metabolism in patients with cerebral aneurysms: clipping vs. endovascular embolization
文章编号:
1009-153X(2017)06-0410-03
作者:
周 智
610200,成都市双流区第一人民医院神经外科
Author(s):
ZHOU Zhi.
Department of Neurosurgery, The first people’s Hospital of Shuangliu District, Chengdu City, Chengdu 610200, China
关键词:
颅内动脉瘤夹闭术血管内栓塞血流动力学
Keywords:
Cerebral aneurysms Surgical clipping Endovascular embolization Cerebral hemodynamics Cerebral energy metabolism
分类号:
R 739.41; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2017.06.015
文献标志码:
A
摘要:
目的 比较夹闭术和血管内栓塞治疗对颅内动脉瘤病人血流动力学和能量代谢的影响。方法 2013年8月至2015年8月收治颅内动脉瘤134例,根据治疗方法分为夹闭组(65例)和栓塞组(69例)。夹闭组采用夹闭术治疗,栓塞组采用血管内栓塞治疗。术后3个月采用改良Rankin量表(mRS)评分和GOS评分评估疗效。进入手术室时(T1)、全身麻醉后(T2)、手术开始时(T3)、手术结束时(T4)记录血流动力学和能量代谢指标。结果 两组术后3个月GOS、mRS评分无明显差别(P>0.05)。栓塞组动脉瘤破裂发生率明显高于夹闭组(P<0.05)。夹闭组T4时刻平均动脉压较栓塞组低(P<0.05),葡萄糖摄取率较栓塞组高(P<0.05);两组心率、血红蛋白、红细胞压积、二氧化碳分压、颅内压、脑血流量、葡萄糖浓度、丙酮酸、脑动-静脉血氧含量差及脑颈静脉球-动脉乳酸差值等指标均无明显差别(P>0.05)。结论 夹闭术和血管内栓塞治疗颅内动脉瘤疗效相当;夹闭术治疗颅内动脉瘤并发症发生率低于血管内栓塞,但血管内栓塞比夹闭术更能维持血流动力学相对稳定。
Abstract:
Objective To compare the changes in the cerebral hemodynamics and cerebral energy metabolism produced by clipping (craniotomy) with those by endovascular embolization in the patients with cerebral aneurysms. Methods Of 134 patients with cerebral aneurysms, 65 (clipping group) underwent craniotomy from the clipping of aneurysms and 69 (embolization group) were treated by endovascular embolization from August, 2013 to August, 2016. The curative effects and changes in cerebral hemodynamics and cerebral energy metabolism were observed and compared between both the groups. Results There were no significant differences in the scores of GOS and mRS after the treatment between both the groups (P>0.05). The rate of occurrence of aneurysm rupture was significantly higher in embolization group than that in clipping group (P<0.05). The mean arterial pressure [(75.26±12.12) mm Hg] was significantly lower in clipping group than that [(82.24±11.34) mmHg] in embolization group (P<0.05), but glucose uptake rate in clipping group was significantly higher in clipping group than that in embolization group (P<0.05) immediately after the treatment. There were no significant differences in heart rate, hemoglobin level, hematocrit value, intracranial pressure, glucose concentration, cerebral blood flow, pyruvic acid concentration, difference between the cerebral arterial oxygen content and jugular venous oxygen content and difference between jugular venous lactic acid content and cerebral arterial lactic acid content between both the two groups (P>0.05). Conclusions There is insignificant difference in the clinical curative effects on the cerebral aneurysms between the clipping and endovascular embolization. The rate of aneurysm rupture occurrence was significantly lower in the patients undergoing the clipping than that in the patients undergoing endovascular embolization, but the endovascular embolization can better maintain relatively stable hemodynamics and cerebral energy metabolism compared to the clipping in the patients with cerebral aneurysms.

参考文献/References:

[1] Choi SW, Ahn JS, Park JC, et al. Surgical treatment of unruptured intracranial middle cerebral artery aneurysms: angiographic and clinical outcomes in 143 aneurysms [J]. J Cerebrovasc Endovasc Neurosurg, 2012, 14(4): 289-294.
[2] Feng Z, Li Q, Zhao R, et al. Endovascular treatment of middle cerebral artery aneurysm with the LVIS Junior stent [J]. J Stroke Cerebrovasc Dis, 2015, 24(6): 1357-1362.
[3] 陈 志,唐卫华,缪洪平,等. 大脑中动脉动脉瘤破裂伴脑 内血肿的早期手术治疗[J]. 第三军医大学学报,2012,30 (24):2324-2326.
[4] 宋炳伟,甄 勇,何 亮,等. 显微夹闭手术时机对高分级 动脉瘤性蛛网膜下腔出血患者预后的影响[J]. 中国脑血 管病杂志,2015,12(7):352-355.
[5] Kadkhodayan Y, Delgado Almandoz JE, Fease JL, et al. Endovascular treatment of 346 middle cerebral artery aneu- rysms: results of a 16-year single-center experience [J]. Neurosurgery, 2015, 76(1): 54-60.
[6] Diaz OM, Rangel-Castilla L, Barber S, et al. Middle cerebral artery aneurysms: a single-center series comparing endo- vascular and surgical treatment [J]. World Neurosurg, 2014, 81(2): 322-329.
[7] 郭金满,胡火军. 显微外科夹闭手术与血管内介入治疗颅 内动脉瘤的疗效比较[J]. 中国老年学杂志,2012,8(8): 139-140.
[8] 于晓波,张可帅. 显微外科手术和血管内介入栓塞术治疗 颅内动脉瘤62例临床分析[J]. 中国医药科学,2012,8 (7):178-179.
[9] 赵宝帅. 显微神经外科手术和血管内介入疗法应用于颅 内动脉瘤患者的比较研究[J]. 中国医药导刊,2013,10 (8):436-438.
[10] 刘世伟. 血管内介入栓塞术与开颅夹闭术治疗脑动脉瘤 临床疗效观察[J]. 中国现代药物应用,2015,9:68-69.

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更新日期/Last Update: 2017-06-25