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目的 探讨显微手术治疗破裂脑动脉瘤的要点及防治血管痉挛的措施。方法 对173例早期手术治疗的破裂脑动脉瘤进行回顾性分析。结果 发生症状性血管痉挛15例。出院1～3个月,恢复良好者141例,轻残者15例,重残者6例,死亡11例。结论 早期手术治疗破裂脑动脉瘤不仅可杜绝再出血的危险,且利于血管痉挛的防治。术中解剖瘤蒂时避免钝性剥离及暂时阻断载瘤动脉对防止术中动脉瘤破裂是至关重要的。应用罂粟碱溶液冲洗脑池,同时行腰部蛛网膜下腔外引流以及应用免疫抑制剂对防治血管痉挛有一定疗效。
Objective To investigate the main points of microsurgical treatment of ruptured cerebral aneurysm and the measures to prevent and treat vasospasm. Methods A retrospective analysis of 173 cases of early ruptured cerebral aneurysms was performed. The results of symptomatic vasospasm in 15 cases. One to three months after discharge, there were 141 cases with good recovery, 15 cases with mild disability, 6 cases with severe disability and 11 cases with death. Conclusion Early surgical treatment of ruptured cerebral aneurysm can not only eliminate the risk of rebleeding, but also conducive to the prevention and treatment of vasospasm. Intraoperative dissection of tumor pedicle to avoid blunt dissection and temporary blocking of the parent artery to prevent intraoperative aneurysm rupture is essential. Application of papaverine solution washing brain pool, at the same time lumbar subarachnoid drainage and the application of immunosuppressive agents on the prevention and treatment of vasospasm have a certain effect.