Chinese Medical Sciences Journal ›› 2016, Vol. 31 ›› Issue (2): 89-94.doi: 10.1016/S1001-9294(16)30031-1

• Orginal Article • Previous Articles     Next Articles

Impact of Intraoperative Blood Pressure Control and Temporary Parent Artery Blocking on Prognosis in Cerebral Aneurysms Surgery

Min Xu1, 2, Zheng-song Gu3, Cun-zu Wang2, 4, *, Xiao-feng Lu2, Ding-chao Xiang2, Zhi-cheng Yuan5, Qiao-yu Li5, Min Wu6   

  1. 1Department of Neurosurgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, Jiangsu 215300, China; 2Department of Neurosurgery, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, China; 3Department of Neurosurgery, Zhenjiang Hospital of Traditional Chinese Medicine, Zhenjiang, Jiangsu 212001, China; 4Department of Neurosurgery, Wound Institute of Jiangsu University, Zhenjiang, Jiangsu 212001, China; 5Department of Neurosurgery, Zhenjiang First People’s Hospital, Zhenjiang, Jiangsu 212001, China; 6Department of Neurosurgery, the Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China
  • Received:2015-09-30 Published:2016-06-20 Online:2016-06-20
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Objective In cerebral aneurysm clipping and embolization, blood pressure control and temporary parent artery blocking are common methods to prevent aneurysm rupture. Their influence on the prognosis is uncertain. In this study, we try to find out the association between methods above and prognostic indicators.Methods We held a retrospective analysis on patients’ medical records of cerebral aneurysms surgical clipping and endovascular coiling , and recorded gender, age, diagnosis, Hunt-Hess grade, Glasgow coma scale score, treatment methods, a history of hypertension, preoperative systolic blood pressure, with or without controlled hypotension, systolic blood pressure difference before and after controlled hypotension, with or without temporary artery blocking, with or without hypertension after treated aneurysm, prognostic indicators including mortality after 1 month, intensive care unit (ICU) stay time of survivors, discharged Glasgow outcome scale (GOS) score. Prognostic indicators were regarded as dependent variable, all the factors were regarded as independent variable, and the strength analysis of influence factors on prognostic indicators was made by binary logistic regression.Results Total cases were 165, including 68 males and 97 females, with an average age of 56 (12-85) years. The mortality after 1 month was 10.9% (18 cases). The ICU stay time of survivors was 7.35 (0-67) days. GOS score at discharge was 1-3 in 40 (24.2%) patients and 4-5 in 125 (75.8%) patients. Systolic blood pressure difference before and after controlled hypotension was an independent factor influencing mortality (t=2.273, P=0.024), and the greater the difference was, the higher the mortality would be. Timely hypertension after aneurysm treated was an independent factor affecting ICU stay time of survivors and patients with hypertension had shorter ICU stay time (χ2=10.017, P=0.001). Blood pressure control (χ2=0.088, P=0.767) and temporary blocking (χ2=1.307, P=0.253) did not show significant influence on GOS score at discharge.Conclusions Timely controlled hypertension after aneurysm clipping and embolization can significantly shorten the stay time in ICU. The degree of controlled hypotension associates with postoperative mortality, the greater systolic blood pressure difference before and after antihypertensive treatment is, the higher the mortality will be.

Key words: cerebral aneurysm, intraoperative blood pressure control, prognosis, temporary parent artery blocking

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