Aneurysm complication
Complications of Aneurysm include Hydrocephalus, aneurysm re-rupture, cerebral vasospasm, hematoma at puncture site, cerebral infarction, lower limb thrombosis, delayed type hypersensitivity and more.
1, aneurysm re-rupture. Endovascular embolization is a serious Aneurysm complication due to the rapid fluctuations in blood pressure, during mechanical stimulation, postoperative anticoagulant therapy-induced changes in clotting mechanisms. Tumor rupture with age and mortality increases. A patient may suddenly appeared nervous, painful expression, restless, severe headache, varying degrees of consciousness, urine incontinence. CT showed subarachnoid hemorrhage, lumbar puncture can be seen bloody cerebrospinal fluid. Care of patients must be carefully observed at any time, timely and informed the doctors found a timely manner. Income after careful observation of neurosurgical ICU patients state of consciousness, pupillary changes, physical activity, vital signs, especially blood pressure and respiratory changes. Control of high blood pressure lower blood pressure fell to 16 / 1 lKpa around. Patients on a clear, guiding its absolute bed rest 48 ~ 72h, 48h with shaking his head not to keen to maintain emotional stability and smooth bowel movement.
2, cerebral vasospasm. Intracranial aneurysm is a common complication after embolization. If the patient has been the emergence of a neurological deficit, such as headache, decreased blood pressure, short-term sense of obstacles and paralysis of limbs, may be caused by cerebral vasospasm. Doctors should timely report to carry out the expansion, spasmolytic treatment. Sustained low-flow oxygen, to improve the brain tissue hypoxia. Patient care at any time to pay special attention to changes in the nervous system symptoms, and psychological care of patients to do a good job. Angiography, spasm that caused by embolization is continuous in 3 to 4 weeks, to prevent cerebral vasospasm, the clinical effect of the commonly used micro-pump with the pump continued. Nimotop is a highly selective role in the brain tissue calcium antagonists, it can direct the expansion of cerebral blood vessels, increase in cerebral blood flow can act on neuronal cells, to enhance its anti-ischemic, the ability of hypoxia, to accelerate the resumption of their normal physiological activities. Nimodipine in the application should be closely monitored at the same time heart rate, blood pressure changes, such as blood pressure fell, face flushing, palpitations and other reactions should be slowed down or stopped fluid drop. At the same time, given rehydration, treatment and support expansion.
3, hematoma at puncture site. Hematoma may be complicated by aneurysm after 6h in the postoperation, the elastic arteries due to poor or excessive intraoperative heparin clotting mechanism obstacles puncture after physical activity side, the different local efforts, such as oppression. Mainly for local swelling, purple blood. Patients after completion of the security back to the wards, we asked the patient lying 24h, the wounds of oppression sandbags 6h, puncture site at the same time cut leg buckling, brake. Puncture point at any time to observe local bleeding, hematoma situation. Small hematoma not normally dealing with, after a few days to subside. Such as the large amount of bleeding, blood pressure drop, large hematoma, with the exception of femoral artery compression bandage pressure outside, 24h after partial heat, foot elevation, in order to facilitate venous return, and to observe the situation of patients with dorsalis pedis artery pulse.
4, the formation of cerebral infarction. Postoperative thrombosis or thromboembolism caused by cerebral infarction is one of surgical complications. In severe cases, may be due to cerebral artery occlusion, ischemia and death of brain tissue. Should be observed closely after the early language, motor and sensory function of changes in the exchange with patients for early detection of changes in condition. Such as found in the side of postoperative limb weakness, paralysis, unconsciousness and even such as aphasia. Should consider the possibility of cerebral infarction, immediately notify a doctor in time to deal with. Postoperative hypercoagulable state in patients with conventional heparin given 48h of short-term, with the long-term aspirin therapy to prevent cerebral infarction. Closely monitor whether treatment bleeding tendency, 10 ~ 30min each time blood pressure, and detailed records, observation of gums, conjunctiva, skin and any bleeding points, urine color, as well as headache, vomiting and other symptoms of intracranial hemorrhage.
5, lower limb thrombosis. Embolization, the different levels of vascular endothelial damage may be caused by the formation of lower extremity arterial thrombosis. The performance of the operative side to the skin to varying degrees of lower extremity or lower extremity pain cyanosis obvious than the contralateral dorsalis pedis artery pulse significantly reduced, suggesting the possibility of thrombosis of lower extremities. 15 ~ 30min after each touch 1 dorsalis pedis, observation of lower extremity peripheral circulation, such as the dorsalis pedis artery pulse weakening or disappearance of any skin color, temperature and pain are normal. Because patients in the postoperative hypercoagulable state, paralysis of limbs, mental stress, lack of appropriate activities, once the cause of lower extremity venous thrombosis, the absolute bed-ridden patients asked, run-up limb, in favor of venous return, limiting physical activity, prescribed to give thrombolytic therapy, anticoagulant medication.
6, delayed type hypersensitivity. Ionic contrast agent applications prone to allergic reactions, but some patients with non-ionic contrast agent allergy may occur. Contrast agents enter the body a long time and large dose, allergy symptoms can be similar. Performance for mild allergies: headache, nausea, vomiting, skin itching, urticaria, etc. were re-shock, difficulty in breathing, convulsions and other limbs. Therefore, close observation of changes in condition, familiar with the contrast agent to deal with allergic reactions.
7, Hydrocephalus is the most common aneurysms postoperative complications. Acute hydrocephalus in brain surgery at the same time line that is able to resolve the outdoor drainage, and chronic hydrocephalus required shunt surgery.