| Objective:Retrospective analysis of clinical data of embolization of cerebral arteriovenous malformation,to explore the mechanism of normal perfusion pressure breakthrough (NPPB). Analysis the angioarchitecture Imaging before embolization intraoperative surgical techniques and postoperative-related treatment measures; and on this basis, summed up the NPPB of prevention measure. Improve the research of the controlled hypotension measures in order to perfect the prevention and treatment measures in NPPB. Provide theoretical support and the accumulation of clinical experience for prevention and treatment of NPPB in the embolization of arteriovenous malformation, improve the success rate of the embolization of AVM, reduce morbidity and mortality of embolization.Materials and methods:The first part, retrospective analysis of56cases clinical data of embolization of cerebral arteriovenous malformation from2007-2012. Carefully analysis the angioarchitecture imaging before embolization, then endovascular embolization of cerebral arteriovenous after general anesthesia. Take a series of related measures of intraoperative and postoperative;and on this basis, summed up the of prevention and treatnnent measures of NPPB.The second part, selected40cases from AVM treated from2007-2012divided into observation group and control group (n=20). Analysis whether it is effectivethe about improved controlled hypotension measures of prevention and treatment of NPPB. Control group is the conventional antihypertensive methods using sodium nitroprusside or nitroglyceol; Observation group using remifentanil and metoprolol tartaric acid equipped with the dexmedetomidine. Both groups, did adjust according to blood pressure, controlled arterial blood pressure in2/3of the basal blood pressure and maintain24-72h. All patients using a multifunctional monitor monitoring HR, MAP, record the control of MAP after half an hour,6h,18h,24h; recorded awake time, extubation time, restless and Ramsay sedation score; record arterial blood pressure and heart rate during suctioning, extubation. Inspection and index data in SPSS17.0statistical software,measurement data in x±s,groups were analyzed using t-test. P<0.05for the difference was significant.Results:56cases of patients with cerebral AVM embolizated, in the8case large AVM,including six cases of patients interval2M for2nd embolization, two cases in three embolization,8cases of cerebral angiography showed more than80%embolized of the vascular malformation group,4cases completely embolized; small and medium-sized AVM once embolized48cases,34cases50%embolized,10cases50%embolized,4cases <50%embolized;two cases blood pressure fluctuations lead to NPPB due to anesthesia lightening, endotracheal intubation stimulation after embolized return to the ward, underwent to hemicraniectomy and conservative treatment; this group of cases with no deaths. The improvement of controlled hypotension, in the time of suction extubation, the differences between observation group and control group of arterial pressure and heart rate were statistically significant (P<0.05); Patient recovery time, time to extubation was no significant difference (P>0.05).Agitation,Ramsay sedation scale of the observation group compared with the control group was statistically significant (P <0.05); MAP reached the target after antihypertensive, the two groups was no significant difference (P>0.05), the differences of the HR of two groups after antihypertensive,were statistically significant (P<0.05).Conclusion:The prevention and treatment of NPPB should take comprehensive measures.Carefully analysis the angioarchitecture imaging and clinical data before embolization, the AVM with NPPB high-risk factors should be particularly cautious in embolization. TCD and SPECT monitoring preoperative and postoperative if necessary to further predict the risk of NPPB after treatment; maintain anesthesia24h and controlled hypotension after embolization,graded embolization of large AVM,rational drug therapy can effectively reduce the risk of NPPB; close monitoring of vital signs and imaging findings help early detection of NPPB,timely and effective treatment is very important to the reduction of NPPB mortality and morbidity. Controlled hypotension, remifentanil and metoprolol tartaric acid equipped with the dexmedetomidine antihypertensive effect,the process smooth, can effectively inhibit the suction,cough, restlessness,extubation and other stress response caused fluctuations of blood pressure in antihypertensive process, reducing the occurrence of NPPB. |
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