摘要
目的探讨颅内动脉瘤手术中可能导致动脉阻断后脑缺血发生的相关因素。方法１９９４年１０月至１９９７年３月间对２７例颅内动脉瘤进行颅内外动脉的永久和（或）暂时性阻断，阻断前后用激光多普勒血流测定仪（ＬＤＦ）对被阻断动脉供应区脑组织的局部脑血流实施连续监测。将患者性别、年龄、动脉瘤大小、术前动脉瘤分级、阻断前的ＬＤＦ值、阻断后ＬＤＦ最大下降幅度、阻断解除后ＬＤＦ恢复的程度、动脉被阻断的持续时间、阻断次数、被阻断的程度诸变量进行单因素分析，探讨动脉阻断后可能导致缺血性损伤的原因。结果阻断后ＬＤＦ最大下降幅度、动脉被阻断的持续时间、阻断次数、被阻断的程度与动脉阻断后脑缺血的发生有显著相关。结论ＬＤＦ测定技术能及时了解动脉阻断后局部残存脑血流量的变化趋势及血管的侧支循环能力；动脉阻断后脑组织局部残存血流量若大于正常时的５０％时，动脉阻断持续时间小于２０分钟，暂时性阻断动脉是安全的。
Objective To evaluate parameters, owing to temporary and /or permanent intraoperative arterial occlusion, could be related to the postoperative development of ischemic injury. Method During 3 year period between October 1994 and March 1997, 27 patients with intracranial aneurysm were operated on with the aid of temporary and/or permanent arterial occlusion. Continuous intraoperative monitoring lCBF of the territories undergoing occlusion was carried out using LDF. Univariate analysis was used to study the relationship between the study variable and cerebral infarction. These variables included patient age, sexuality, aneurysm size, preoperative Hunt and Hess grades, LDF baseline value, LDF value following arterial occlusion and release of occlusion, the duration of arterial occlusion, the numbers of occlusive episodes, and the degree of arterial occlusion. Student′s t test was used for comparison of continuous variable such as age, and chi square analysis was used to test the association of categorical variables. Result The LDF value following arterial occlusion or residual lCBF, the duration of arterial occlusion, the numbers of occlusive episodes, and the occlusive degree were found to be significantly related to the postoperative development of ischemic injury. Conclusion The residual lCBF and collateral circulation following arterial occlusion can be evaluated using LDF monitoring. When residual lCBF is more than 50 per cent of the baseline and the duration of arterial occlusion less than 20 minutes, temporary arterial occlusion is safe and does not develop postoperative ischemic injury.
出处
《中华外科杂志》
CAS
CSCD
北大核心
1998年第11期664-667,共4页
Chinese Journal of Surgery
关键词
脑动脉瘤
颅内肿瘤
脑缺血
相关因素
Cerebral aneurysm Factor analysis,statistical Cerebral ischemia
