A Series Of Studies On The Effects Of Intracranial Aneurysm Clipping On Postoperative Clinical Outcomes

Objective The shortage of blood resources has severely influenced the diagnosis and treatment of some underlying bleeding diseases,such as clipping surgery.Whether acute normovolemic hemodilution(ANH)is safe and effective in aneurysm clipping remains largely unknown.This project aims to study the clinical application of ANH and provides new ideas for the efficient use of blood in clinic.MethodsSixty-two aSAHH patients who underwent intracranial aneurysm clipping surgery in our hospital were retrospectively collected in the period of December 2019 to June2020.The selection criteria includes age ≥ 18 years old,gender unlimited,ASA grade Ⅰ-Ⅲ and Hunt-Hess grade 0-Ⅱ.The number of cases includes ANH group(n = 20)and non-ANH group(n = 42).In the ANH group,400 m L of autologous blood was collected before the operation,and colloidal fluid and crystalline body fluid were infused to maintain blood volume.And blood transfusion was performed according to the operation process during the operation.The control group had the same treatment as ANH group except that the collection of autogenous blood and the infusion of dilatancy liquid were not performed.Intraoperative blood transfusion of allogeneic red blood cells and fresh frozen plasma,preoperative and postoperative test results,postoperative complications and other indicators.ResultsANH did not reduce the need of perioperative blood transfusion[3(15%)vs 5(11.9%),P = 0.734].However,ANH significantly increased serum hemoglobin levels on postoperative day 1(11.5 ± 2.5 vs 10.3 ± 2.0,P = 0.045)and day 3(12.1 ± 2.0 vs 10.7± 1.3,P = 0.002).Multivariable analysis indicated that serum hemoglobin levels on post-operative day 1(OR = 0.895,95% CI = 0.822-0.973,P = 0.010)was an independent risk factors for unfavorable outcome,and ROC curve analysis showed that it had a comparable predictive power as WFNS grade(Z = 0.275,P > 0.05).There was no imparity in the rate of fresh frozen plasma infusion between the two groups[(10%)vs 4(9.5%),P = 0.953].For the entire research,the requirement of allogeneic blood transfusion was remarkedly associated with intraoperative aneurysm rupture[7(87.5%)vs 5(9.3%),P < 0.001] and length of surgery[228.0(212.0-315.0)vs 60.0(137.5-185.0),P = 0.002].Rerupture of intraoperative aneurysm was an independent risk factor(OR = 0.024,CI = 0.002-0.272,P = 0.003).Compared with the non-ANH group,there were no differences in the length of hospital stay,preoperative and postoperative coagulation function,electrolyte,bilirubin,urea and other test indicators,as well as the incidence and severity of postoperative complications in the ANH group(P(29)0.05).ConclusionsANH may improve the prognosis of patients by increasing postoperative Hb levels.And it does not affect the stability of hemodynamics and coagulation function,and can be safely applied to patients with aneurysmal subarachnoid hemorrhage during the operation.Objective This study explores the effect of stellate ganglion block on improving the degree of postoperative consciousness impairment in patients with aSAHH undergoing intracranial aneurysm clipping and its impact on short-term prognosis.Methods From September 1,2018 to March 1,2021,45 patients who underwent intracranial aneurysm clipping were enrolled.The selection criteria includes aged 18-65 years,regardless of gender,ASA grade Ⅰ-Ⅲ,Hunt-Hess grade 0-Ⅱ.Twenty-three cases were divided into SGB group and twenty-two cases were divided into non-SGB group.Patients in the SGB group underwent ultrasound-guided SGB after induction of anesthesia,while the non-SGB group did not receive the intervention of SGB,and the rest was the same as the SGB group.Observe and record the GCS scores of the two groups of patients on admission,GCS scores for three consecutive days after operation,and GCS scores on the day of discharge.Record preoperative Glu,intraoperative hemodynamics and basic conditions.Observe and collect postoperative Glu and postoperative complications.To evaluate the GOS score,mRS score and Barthel index on the day of discharge.Comparing the GCS scores of admission,three consecutive days after surgery,the incidence of postoperative complications and short-term prognosis,we analyze that whether SGB would improve the patient’s postoperative impairment of consciousness and its relationship with postoperative outcomes and complications.Results The GCS scores of the SGB group for three consecutive days after operation and at discharge were significantly higher than those of the non-SGB group,and the difference was statistically significant[the first day after surgery:15.0(15.0-15.0)vs15.0(13.5-15.0),P = 0.040;the second day after surgery:15.0(15.0-15.0)vs 15.0(12.5-15.0),P = 0.016,third day after surgery:15.0(15.0-15.0)vs 15.0(11.0-15.0),P = 0.011,The day of discharge: 15.0(15.0-15.0)vs 15.0(12.0-15.0),P = 0.015].No difference in admission GCS score(P > 0.05).Compared with the non-SGB group,the GOS prognostic score was higher in the SGB group[17(73.9%)vs 9(40.9%),P = 0.025],and the length of hospital stay was shortened[10.0(8.0-12.0)vs 12.0(8.0-27.5),P = 0.045].The HR at the intubation time of T0 was significantly lower in the SGB group than in the non-SGB group[67.09±2.81 vs 78.00±3.15,P = 0.013].The difference of postoperative Glu was significant,the SGB group was significantly lower than the non-SGB group [7.86(7.24-9.36)vs 6.23(4.91-7.80),P = 0.003].The incidence of pulmonary infection in the non-SGB group was higher[6(27.3%)vs 0(0.0%),P = 0.024],and there was no significant difference in theincidence of other postoperative complications(P > 0.05).In addition,there were no differences between the two groups in terms of intraoperative MAP(27)50mm Hg,MAP(27)60mm Hg,operation time,blood loss,admission to ICU,time to stay in ICU,and number of patients with tubes after surgery(P > 0.05).Conclusions SGB can improve the postoperative impairment of consciousness of patients with aSAHH undergoing intracranial aneurysm clipping,inhibit excessive stress response,and maintain hemodynamic stability.Aneurysm clipping surgery may consider using stellate ganglion block when necessary to speed up the patient’s rapid postoperative recovery.