Local Cerebral Oxygen Saturation Was Monitored During Intracranial Aneurysm Clipping Correlation Analysis Of Intraoperative Application And Prognosis

Intracranial aneurysm is a common kind of cerebrovascular disease,it is due to local vessels due to arteriosclerosis,trauma and congenital factors such as arterial wall weak special changes and the formation of tumor structure,very common in neurosurgery diseases,often with subarachnoid hemorrhage symptoms as the main clinical manifestations,part by tumor body compression,vasospasm and embolism,aneurysm rupture often lead to patient disability or death,cerebral aneurysm once bleeding will cause serious clinical symptoms and even life-threatening,and bleeding mortality is higher.There are various treatment methods for cerebral aneurysms,but cervical clipping is still one of the most commonly used methods.It aims to maintain the blood supply of the parent artery and its distal vessels,so as to maintain the normal blood supply of brain tissue and prevent cerebral aneurysm from rupture again and bleeding threatening the survival of patients.However,in this operation,in order to prevent massive bleeding when closing the aneurysm neck,it is usually necessary to use a temporary vascular clip to temporarily block the blood flow of the parent artery,so as to effectively reduce the risk of aneurysm rupture and bleeding,and ensure the safety of the patient.After blocking the blood supply to the parent artery,the blood supply to the intraoperative brain tissue will decrease sharply,which will increase the risk of delayed postoperative ischemia,which will lead to impaired nerve function,which makes the patient with poor prognosis and poor recovery.How to judge the relationship between brain tissue ischemia and postoperative nerve dysfunction during temporary parent artery blockade is particularly important,which may be an important link to improve the postoperative prognosis of patients.Objective:In this study,mainly through the temporary blocking of the parent artery during aneurysm clipping,Using a near-infrared spectrometer（NIRS）dynamic monitoring of aneurysmal subarachnoid hemorrhage（a SAH）bilateral frontal cerebral oxygen saturation changes in patients,Then explore the NIRS monitoring technique for the postoperative evaluation of delayed cerebral ischemia（DCI）in occurrence.Methods:Selected 40 aneurysm patients（definite diagnosis by CTA or DSA examination）from August 2021 and were admitted to Handan Central Hospital in June 2022,and all met the relevant inclusion criteria and exclusion criteria,these patients were treated by a high seniority and skilled surgeon within 48 hours after admission,and NIRS was used to dynamically monitor cerebral oxygen saturation changes during surgery.After surgery,all patients were treated routinely in accordance with the 2016 Chinese Guidelines for the diagnosis and Treatment of Aneurysmal subarachnoid hemorrhage.After a rigorous exclusion criteria for screening,Finally identified 40 aneurysm patients who met the inclusion and exclusion criteria,And follow-up by telephone 3 months after discharge,Scoring according to the MRS scale,The 40 patients with ruptured aneurysm were divided into MRS score 1-2 into good prognosis group and MRS score 3–6 into poor prognosis group,To explore the intraoperative NIRS monitoring of cerebral oxygen saturation（rSO₂）and MRS scores 3 months after patient discharge,Predictive effect of postoperative outcome by intraoperative monitored rSO₂values.Results:In this study,a total of 40 patients were included,and all patients received non-invasive NIRS monitoring.In bilateral rSO₂,paired sample t-test results:t=-0.615,P>0.05,no significant statistically significant difference,after blocking the parent artery,paired sample t-test results on two-sided rSO₂:P<0.05,each group showed statistically significant statistical significance,cerebral oxygen saturation was normal,paired t-test results:t=-1.136,P>0.05,no significant statistical significance.The patient was scored by MRS 3 months after discharge to assess the prognosis status,MRS 0-2 patients 23 and MRS 3-6 patients 17,and the incidence of poor prognosis was about 42.5%.The rSO₂value for the good prognosis group was 56.96±3.38%,and the rSO₂value was 48.35±2.21%,and the difference in rSO₂values between the two groups was significant（t=11.57,P<0.05）.Chi-square tests for age,hunt-hess grade,smoking history and history of hypertension were statistically significant.The results of multivariate logistic regression analysis of postoperative DCI showed that:patient age,hunt-hess grade and history of hypertension were risk factors for poor prognosis.Inverse relationship between the lowest intraoperative rSO₂value and the postoperative development of DCI in patients with a SAH,Correlation coefficient-0.815（F=75.405,P<0.05）,The offline area of the ROC curve with the lowest value of intraoperative monitoring was 0.976,With a relatively high level of accuracy,Using the significant decrease in rSO₂value（<50%）as the standard to predict the occurrence of postoperative DCI,With a sensitivity of 82.5%,The specificity was 95.6%,Taking the baseline change of rSO₂value of>20%as the standard to predict the occurrence of postoperative DCI in patients,With a sensitivity of 88.2%,The specificity ratio was 86.9%.Conclusions:This study concluded the application of NIRS monitoring in a SAH patients:1.NIRS monitoring of local cerebral oxygen saturation can be used for intraoperative aneurysm monitoring,which can better reflect the changes of cerebral oxygen saturation in the temporary blocking process;2.Age,hunt-hess grade,and a history of hypertension are the risk factors for DCI;3.There is a significant negative correlation between intraoperative rSO₂monitoring and postoperative DCI,which can be used to evaluate postoperative prognosis of patients during aneurysm;4.The intraoperative monitoring of rSO₂predicts good postoperative prognosis with high accuracy,and the sensitivity and specificity of rSO₂values and rSO₂values are>20%to predict the occurrence of postoperative DCI.For intraoperative patients condition changes,treatment process and prognosis provide reference significance,so that the operator can timely determine the surgical process,quickly clip the aneurysm or remove temporary block,to reduce the nervous system complications,protect the nerve function,minimize the nerve damage and improve prognosis,and provide the application of NIRS in aneurysm related clinical reference data.