Impact of cardio-pulmonary and intraoperative factors on occurrence of cerebral infarction after early surgical repair of the ruptured cerebral aneurysms
Impact of cardio-pulmonary and intraoperative factors on occurrence of cerebral infarction after early surgical repair of the ruptured cerebral aneurysms
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DOI：
10.3340/jkns.2008.43.2.90
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发表时间：
2008-02-01
影响因子：
1.6
通讯作者：
Kim, Kwang-Myung
中科院分区：
文献类型：
--
作者：
Chong, Jong-Yun;Kim, Dong-Won;Kim, Kwang-Myung
目的：迟发性缺血缺损或脑梗死是动脉瘤性蛛网膜下腔出血（SAH）后发病和死亡的主要原因。本研究的目的是重新评估术中因素（包括与手术和麻醉相关的因素）对脑动脉瘤破裂患者发生脑梗死的预后影响。方法：通过对过去 7 年中连续 398 名因破裂脑动脉瘤接受早期显微手术的患者进行回顾性研究，对与手术和麻醉相关的变量以及预定因素进行评估。患者被分为以下两类：良好的临床分级（Hunt-Hess I 至 III）和较差的临床分级（IV 和 V）。终点事件为脑梗死，并在术后6个月测量临床结果。结果：术中破裂、临时夹闭和回缩时间延长、术中低血压或O2饱和度降低时，脑梗死的发生率较高，但两个不同临床组之间无统计学意义。除了Fisher Grade之外，多元逻辑回归分析显示，临时剪断时间、低血压和低O 2 饱和度的比值比分别为1.574、3.016和1.528。脑梗塞和预后存在有意义的相关性（gamma=0.147，p=0.038）。结论：本研究结果表明，由于大脑脆弱性或伴随心肺功能障碍，低级别 SAH 患者的早期手术存在持续缺血性并发症的显着风险。因此，应非常谨慎地接触这些患者，通过与神经麻醉师点对点的共同努力来克服任何预期的术中威胁。
Objective : Delayed ischemic deficit or cerebral infarction is the leading cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study is to reassess the prognostic impact of intraoperative elements, including factors related to surgery and anesthesia, on the development of cerebral infarction in patients with ruptured cerebral aneurysms.Methods : Variables related to surgery and anesthesia as well as predetermined factors were all evaluated via a retrospective study on 398 consecutive patients who underwent early microsurgery for ruptured cerebral aneurysms in the last 7 years. Patients were dichotomized as following; good clinical grade (Hunt-Hess grade I to III) and poor clinical grade (IV and V). The end-point events were cerebral infarctions and the clinical outcomes were measured at postoperative 6 months.Results : The occurrence of cerebral infarction was eminent when there was an intraoperative rupture, prolonged temporary clipping and retraction time, intraoperative hypotension, or decreased 02 saturation, but there was no statistical significance between the two different clinical groups. Besides the Fisher Grade, multiple logistic regression analyses showed that temporary clipping time, hypotension, and low 02 saturation had odds ratios of 1.574, 3.016, and 1.528, respectively. Cerebral infarction and outcome had a meaningful correlation ( gamma=0.147, p=0.038).Conclusion : This study results indicate that early surgery for poor grade SAH patients carries a significant risk of ongoing ischemic complication due to the brain's vulnerability or accompanying cardio-pulmonary dysfunction. Thus, these patients should be approached very cautiously to overcome any anticipated intraoperative threat by concerted efforts with neuro-anesthesiologist in point to point manner.