目的 分析颅内动脉瘤弹簧圈栓塞治疗术中出血的原因和防治对策。 方法 回顾性分析2003年3月－2012年8月358例颅内动脉瘤采用弹簧圈栓塞治疗患者，7例弹簧圈栓塞过程中出血，并继续栓塞止血。2例为弹簧圈栓塞中造影仅见血流明显变慢，术后CT证实的出血。术后对症治疗6例，开颅引流减压3例。 结果 9例术中破裂者中8例致密栓塞，1例部分栓塞。5例恢复好，1例一过性动眼神经麻痹，3例死于颅内高压 结论 术中出血与手中操作、动脉瘤形态和患者血管条件、血压变化有关，继续填塞及合理术中与后续治疗可以挽救大部分患者生命。
Central nervous system vascular disease can be combined with a variety of ocular signs, such as orbital pain, flash, visual field defects, vision loss, eye muscle paralysis. Therefore, some patients were first diagnosed in ophthalmology, including aneurysm rupture, arterial dissection, cerebral apoplexy and other critical nervous system diseases that need rapid treatment. If the doctors didn't know enough, the diagnosis and treatment might be delayed. Most of the vascular diseases of the central nervous system related to ophthalmology have clinical manifestations that cannot be explained by ophthalmology. In the face of chronic conjunctivitis, unexplained visual field defect or cranial nerve paralysis with local ineffective treatment, it is necessary to broaden the thinking of differential diagnosis. To understand the characteristics of vascular diseases of the central nervous system that are prone to ocular manifestations can provide references for the clinical diagnosis and treatment of ophthalmology.
目的 探讨白细胞介素1α（IL-1α）基因多态性与颅内动脉瘤发生的关系。 方法 以2010年6月－2012年3月145例颅内动脉瘤患者和181例正常对照者为研究对象，采用聚合酶链反应-限制性片段长度多态性检测IL-1α-889C/T和+4845G/T多态性，统计分析基因多态性与颅内动脉瘤的相关性。 结果 IL-1α-889C/T位点：CT/TT基因型在颅内动脉瘤组中的频率为32.4%，显著高于其在对照组中的频率（21.5%），两组相比差异有统计学意义（χ2=4.90，P＜0.05）；T等位基因在颅内动脉瘤组中的频率为16.9%，显著高于其在对照组中的频率（10.8%），两组相比差异有统计学意义（χ2=5.17，P＜0.05）。IL-1α+4845G/T多态性在两组人群中的分布差异无统计学意义（P＞0.05）。 结论 IL-1α -889C/T多态性与颅内动脉瘤的发病有关，-889T等位基因可能是颅内动脉瘤的遗传易感基因。
【摘要】 目的 探讨基层医院显微外科手术治疗动脉瘤性蛛网膜下腔出血（aSAH）的手术时机、方法以及疗效。 方法 回顾分析2005年1月-2009年12月经翼点入路行显微外科手术治疗的36例aSAH患者的临床资料。 结果 所有aSAH患者经数字减影血管造影检查确诊，均行瘤颈夹闭术。手术效果按GOS评分，恢复良好30例（83%）、中度残疾4例（11%）、死亡2例（6%）。 结论 aSAH按Hunt-Hess分级为Ⅰ～Ⅱ级的患者应尽早手术， Ⅲ～Ⅳ级应结合患者颅内出血量及全身状况综合考虑，Ⅴ级待病情稳定后积极手术治疗。经翼点入路显微外科手术治疗前循ASAH，手术中暴露清楚，夹闭瘤颈可靠，疗效满意。【Abstract】 Objective To explore the operative time, methods and curative effect of microsurgical treatment on aneurysmal subarachnoid hemorrhage (aSAH) in basic-level hospitals. Methods The data of 36 patients with aSAH who had undergone microsurgery from January 2005 to December 2009, were retrospectively analyzed. Results All the patients were confirmed as aSAH by digital subtraction angiography, and all of them had undergone clapping of aneurism. According to GOS, 30 patients (83%) had good recovery, four patients (11%) had moderate disability and two patients (6%) died. Conclusions The operation should be done as early as possible in the patients with gradeⅠ-Ⅱ of Hunt-Hess, the volume of intracranial hemorrhage and patient’s condition should be considered to decide when to operate of grade Ⅲ-Ⅳ, patients with grade Ⅴ aneurysms should be treated by conservative therapy first. They should consider an operation only when their condition is stable after conservative therapy. The peritoneal approach is a good procedure because of clear exposure, reliable clipping and satisfactory results.
ObjectiveTo explore the nursing method to avoid rupture of intracranial aneurysm during induction of anesthesia. MethodWe retrospectively analyzed the nursing method for 428 patients with aneurysm during the induction of anesthesia between October 2012 and October 2013. According to the causes of rupture of intracranial aneurysm (anxiety, tension, excitement, sudden elevation of blood pressure, physical labor), we adopted nursing methods to avoid those causes, and implemented targeted nursing methods during induction of anesthesia. ResultsNo intracranial aneurysm rupture occurred in these 428 aneurysm patients during induction of anesthesia. Two patients' absolute value of systolic blood pressure was below 80 mm Hg (1 mm Hg=0.133 kPa) during induction of anesthesia, and the vital signs of other patients kept normal. The number of intraoperative rupture cases was 3. When discharged from hospital, there were 385 patients with good prognosis, 39 patients with bad prognosis, and 4 death cases. ConclusionsTargeted nursing method based on patients' particular situation during induction of anesthesia can effectively control patients' emotion, stabilize fluctuations in hemodynamic indexes, decrease the incidence of aneurysm rupture, improve surgery treatment effect of intracranial aneurysm clipping, decrease complications, and improve patients' prognosis.
ObjectiveTo summarize the experience of microsurgery in primary hospital for the posterior communicating artery aneurysms (PCOAan). MethodsThe clinical data of 48 patients with PCOAan who underwent microsurgery from January 2008 to December 2012 were retrospectively analyzed. ResultsAll the necks of aneurysms of 48 cases were successfully clipped, Acording to the Glasgow outcome score (GOS), the early curative effects were good in 36 cases (75.0%, GOS 4-5) poor in 10 cases (20.8%, GOS 2-3) and death in 3 cases (2.1%, GOS 1). After the operation was carried out, the operation time was shorten, aneurysm intraoperative rupture rate was lower, postoperative complications were lower, and the average medical expense was reduced; the difference was significant in 24 cases before and after the operation (P<0.05). ConclusionMicrosurgery for PCOAan is an effective method which should be popularized in primary hospitals.
ObjectiveTo investigate the value of head boneless CT angiography (CTA) for surface shaded display (SSD) (hereinafter referred to as the SSD-CTA technology) and volume computed tomographic digital subtraction angiography (VCTDSA) in diagnosing intracranial aneurysms. MethodsWe collected the clinical data of 35 patients diagnosed to have intracranial aneurysm by VCTDSA between April 2013 and November 2014 from the First Affiliated Hospital of Chongqing Medical University. The original data were imported into the CT workstation of the First People's Hospital of Chengdu. Then, SSD-CTA technology was performed for bone reconstruction. We compared the results of these two technologies. In addition, we selected another 27 patients diagnosed with intracranial aneurysm by SSDCTA and DSA examination at the same time between June 2012 and November 2014 in the First People's Hospital of Chengdu for comparison. ResultsThe quality score of SSD-CTA reconstructed image was lower than that of VCTDSA, but the diagnosis of the two technologies for intracranial aneurysm was not statistically different (P>0.05). Compared with DSA, the sensitivity and specificity of the diagnosis for intracranial aneurysms by SSD-CTA were both 100%. ConclusionSSD-CTA is valuable in diagnosing intracranial aneurysms.