摘要
目的评价体感诱发电位(somatosensory evoked potential,SEP)、微血管多普勒(microvascular doppler sonography,MDS)和吲哚菁绿荧光造影(indocyanine green angiography,ICGA)在颅内动脉瘤夹闭术中联合应用价值。方法 158例颅内动脉瘤患者术中采用SEP和MDS监测,根据术中SEP和MDS的变化调整瘤夹;28例患者术中采用SEP、MDS和ICGA监测。术后复查CT血管造影(CTA)和数字减影血管造影(DSA),术后1月行格拉斯哥预后评分(GOS)。结果术中19例出现SEP一过性变化。应用MDS监测,6例夹闭后瘤体残留血流信号,调整瘤夹后血流信号消失;39例夹闭后载瘤动脉狭窄,调整瘤夹位置后血流恢复正常。28例ICGA,3例发现瘤颈残留,3例穿支血管闭塞,重新调整瘤夹位置后,再次ICGA证实动脉瘤颈夹闭满意。术后CTA或DSA检查未见瘤体残留,载瘤动脉与邻近血管通畅,与术中SEP和MDS监测结果一致。术后1个月随访,GOS评分优良111例、轻残22例、重残14例、植物生存5例、死亡6例。结论颅内动脉瘤术中进行SEP、MDS和ICGA联合监测,可有效降低手术并发症,提高手术疗效和患者术后生活质量,并能相互弥补不足。
Objective To evaluate the efficacy of intraoperative somatosensory evoked potential（SEP）, microvascular doppler sonography（MDS） and indocyanine green angiography （ICGA） monitoring in intracranial aneurysm clipping surgery. Methods 158 patients undergoing intracranial aneurysm clipping surgery were evaluated with intraoperative SEP and MDS and the clips were reposi- tioned according to the findings of MDS and SEP. 28 cases with the intraoperative combined monitoring of SEP, MDS and ICGA. Patients were reexamined with CT angiography （CTA） or digital subtraction angiography （DSA） were reexamined after operation, and were eval- uated with Glasgow outcome scale （GOS） one month after operation. Results There were transient intraoperative SEP changes in 19 cases. Persistent blood flow through the aneurysmal sac was revealed in 6 aneurysms after clipping, and the clips were repositioned. Par- ent artery stenosis after clipping was indicated by MDS in 39 cases, and the clips were repositioned. 28 cases with the ICGA ： residual aneurysm neck was found in 3 ,occlusion of branching vessels in 3. The ICGA performed after clip replacement showed perfect residual elimination without abnormal findings. CTA or DSA revealed that there was no aneurysmal residue and stenosis of parent and adjacentvessels,which was in line with the findings by SEP and MDS during operation. Patients were followed up 1 month after operation, recovery was excellent or good in 111 patients, mild disability in 22 cases, se- vere disability in 19 patients and 6 deaths. Conclusion Application of the combined monitoring of SEP, MDS and ICGA in the surgery of cerebral aneurysm is able to decrease surgical complications, improve surgical quality and the quality of patients＇ postoperative life. SEP,MDS and ICGA could complement rather than replace with each other.
出处
《实用医院临床杂志》
2013年第5期3-6,共4页
Practical Journal of Clinical Medicine
关键词
体感诱发电位
微血管多普勒超声
吲哚菁绿荧光造影
术中监测
动脉瘤
夹闭术
Somatosensory evoked potential
Microvascular doppler sonography
Indocyanine green angiography
Intraoperativemonitoring
Aneurysm
Clipping
