摘要
目的探讨支架辅助弹簧圈栓塞颅内动脉瘤在围手术期严重神经系统并发症的类型和转归。方法回顾性分析2014年1月至2015年7月首都医科大学宣武医院支架辅助弹簧圈栓塞颅内动脉瘤203例患者(其中破裂动脉瘤45例,未破裂动脉瘤158例)中发生围手术期严重神经系统并发症11例患者(13个动脉瘤)的临床资料。结果发生严重神经系统并发症的11例患者接受13枚支架置入治疗,并发症发生率为5.4%(11/203),破裂动脉瘤组严重神经系统并发症发生率为11.1%(5例);未破裂动脉瘤组严重神经系统并发症发生率为3.8%(6例)。破裂动脉瘤组术中动脉瘤破裂出血1例,术后支架内血栓形成1例,发生率均为2.2%;术后再出血2例,发生率为4.4%;麻醉诱导期出血1例,发生率为2.2%。未破裂动脉瘤组术中动脉瘤破裂和术后支架相关缺血各3例,发生率均为1.9%;无麻醉诱导期出血和术后再出血。随访3个月时,格拉斯哥预后评分2分2例,3分1例;8例患者死亡,总病死率为3.9%。结论支架辅助弹簧圈栓塞治疗颅内动脉瘤围手术期可发生支架相关缺血、动脉瘤术中及术后出血等严重神经系统并发症,导致重残甚至死亡,应加强围手术期管理。
Objective To analyze the perioperative clinical character of the severe neurological complications in intracranial aneurism treated with stent-assisted coiling（SAC）. Methods 203 cases of intracranial aneurysms patients treated by SAC were enrolled retrospectively （ ruptured aneurysm group 45 cases and un-ruptured, aneurysm group 158 cases） and the perioperative clinical character of the serious neurological complications（ 11 cases） was further analyzed. Results The total rate of serious neurological complication was 5. 4% ,11 cases of patients with 13 aneurysms got 13 stents. In the ruptured aneurysm group, 5 cases（ 11.1% ） suffered severe neurological complications ,including intraoperative bleeding in one case, postoperative stent-related ischemia in one case, both 2. 2%. Postoperative bleeding 2 cases （ 4. 4% ）, and one case of bleeding during anesthesia induced stage（2. 2% ）. In the unruptured aneurysm group,intraoperative bleeding in three cases, and postoperative stent-related ischemia in three cases, both 1.9%. No bleeding case during anesthesia induced stage or postoperative period. Although active rescue treatments were performed, 8 patients eventually died, and the total mortality rate was 3. 9%. Conclusion Intracranial aneurysms patients following SAC treatment may suffer from bleeding, ischemia, severe neurological complications, severe disability, and even die. So, we have to strengthen perioperative management.
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2016年第5期262-265,共4页
Chinese Journal of Cerebrovascular Diseases
基金
国家自然科学基金(81541120)
北京市科委首都特色发展专项课题(Z151100004015095)
关键词
颅内动脉瘤
支架辅助
并发症
预后
Intracranial aneurysm
Stent-assisted coiling
Complication
Prognosis
