Giannotta S L, Oppenheimer J H, Levy M L, Zelman V
Department of Neurosurgery, University of Southern California, School of Medicine, Los Angeles.
Neurosurgery. 1991 Apr;28(4):531-5; discussion 535-6. doi: 10.1097/00006123-199104000-00008.
A retrospective analysis was performed on all aneurysms operated on by one of us (SLG) from July 1980 to October 1988 to determine the factors that govern outcome from the intraoperative rupture of aneurysms. A total of 276 consecutive surgical procedures for 317 intracranial aneurysms produced 41 perioperative or intraoperative ruptures for analysis. Five cases were pre-exposure ruptures, 3 of which occurred during anesthetic induction. Four of these patients died, and 1 made a good recovery. Of the remaining 36 cases, outcome was analyzed in terms of the adjuncts used to deal with the intraoperative rupture. There was no statistically significant difference in outcome between those cases in which tamponade was used to control hemorrhage versus temporary clipping; however, those cases in which hypotension was used did less well than those in which it was not used. From October 1986 to October 1988, 108 operations for 132 aneurysms were performed without the use of induced hypotension. There were 16 intraoperative ruptures (14.8%). All 16 of these patients made a good recovery. In the group before 1986, of which there were 20 intraoperative ruptures (of 168 operations, 11.9%), 11 of those 20 patients suffered a permanent deficit or died. We conclude that hypotension may not be a necessary adjunct to the management of intraoperative rupture of aneurysms.
对1980年7月至1988年10月期间由我们其中一人（SLG）实施手术的所有动脉瘤进行回顾性分析，以确定影响动脉瘤术中破裂预后的因素。总共对317个颅内动脉瘤进行了276例连续手术，其中41例出现围手术期或术中破裂以供分析。5例为暴露前破裂，其中3例发生在麻醉诱导期间。这些患者中有4例死亡，1例恢复良好。在其余36例中，根据处理术中破裂所采用的辅助措施分析预后。使用填塞法控制出血的病例与临时夹闭的病例在预后方面无统计学显著差异；然而，使用低血压的病例比未使用低血压的病例预后更差。1986年10月至1988年10月期间，对132个动脉瘤进行了108例手术，未使用诱导性低血压。有16例术中破裂（14.8%）。所有这16例患者均恢复良好。在1986年之前的组中，有20例术中破裂（168例手术中的11.9%），这20例患者中有11例出现永久性神经功能缺损或死亡。我们得出结论，低血压可能不是动脉瘤术中破裂处理的必要辅助措施。
