| 121 | 21 | 41 |
| 下载次数 | 被引频次 | 阅读次数 |
目的探讨前列地尔联合尼莫地平在预防动脉瘤性蛛网膜下腔出血后症状性脑血管痉挛发生中的疗效。方法将我科收治的80例Hunt-Hess分级≤Ⅲ级的动脉瘤性蛛网膜下腔出血病例随机分为对照组与治疗组。所有病例入院后早期、足量地给予尼莫地平微泵维持治疗,并在72 h内行手术治疗(夹闭或栓塞)和腰大池引流。术后对照组继续单用尼莫地平,而治疗组加用前列地尔静滴。2组疗程均为14 d。对比2组各临床相关因素及症状性脑血管痉挛发生率。对症状性脑血管痉挛患者行320排CT灌注成像,并测量脑血流量。结果 2组的相关因素除改良Fisher分级及手术方式存在统计学差异外其余均存在可比性。治疗组有4例发生症状性脑血管痉挛,而对照组有11例,治疗组的发生率显著低于对照组。结论对动脉瘤性蛛网膜下腔出血的病例,术后给予前列地尔联合尼莫地平治疗,在预防症状性脑血管痉挛发生上的疗效显著优于单用尼莫地平,值得推广。
Abstract：AIM To investigate the therapeutic effect of alprostadil combined with nimodipine to prevent symptomatic cerebral vasospasm( SCVS) after aneurysmal subarachnoid hemorrhage( a SAH). METHODS A total of 80 patients after a SAH with Hunt-Hess grade ≤3 were randomly assigned to either treatment group or control group. All the patients were given early sufficient nimodipine by minipump for maintenance therapy from the start of hospitalization. The operation( clipping or endovascular embolization) and continuous lumbar cisterna drainage were performed within 72 h. The patients in the control group kept on receiving nimodipine only,meanwhile,alprostadil by intravenous drip infusion was used in the treatment group. The clinical risk factors and incidence of SCVS were observed between 2 groups after 14 d. The CT perfusion imaging was performed in the patients with SCVS,and the value of cerebral blood flow was measured. RESULTS There was no significant difference in the clinical risk factors between 2 groups except the improved Fisher grade and surgical options. SCVS happened in 4 patients of the treatment group and 11 patients of the control group. The incidence of the SCVS in the treatment group was significantly lower than the control group. CONCLUSION Combination treatment of alprostadil and nimodipine is superior to nimodipine used only in the prevention of SCVS after a SAH,and was worth wide application.
[1]Sundt TM Jr.Cerebral vasospasm following subarachnoid hemorrhage:evolution,management,and relationship to timing of surgery[J].Clin Neurosurg,1977,24:228.
[2]Treggiari MM,Suter PM,Romand JA.Review of medical prevention of vasospasm after aneurysmal subarachnoid hemorrhage:a problem of neurointensive care[J].Neurosurgery,2001,48(2):249.
[3]Ohkuma H,Manabe H,Tanaka M,et al.Impact of cerebral microcirculatory changes on cerebral blood flow during cerebral vasospasm after aneurysmal subarachnoid hemorrhage[J].Stroke,2000,31(7):1621.
[4]Dorsch NW.Therapeutic approaches to vasospasm in subarachnoid hemorrhage[J].Curr Opin Crit Care,2002,8(2):128.
[5]Cho WS,Kang HS,Kim JE,et al.Intra-arterial nimodipine infusion for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage[J].Interv Neuroradiol,2011,17(2):169.
[6]Mijailovic M,Lukic S,Laudanovic D,et al.Effects of nimodipine on cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage treated by endovascular coiling[J].Adv Clin Exp Med,2013,22(1):101.
[7]Kin SS,Park DH,Lim DJ,et al.Angiographic feature and clinical outcome of intra-arterial nimodipine injection in patients with subarachnoid hemorrhage-induced vasospasm[J].J Korean Neurosurg Soc,2012,52(3):172.
[8]Kerz T,Boor S,Beyer C,et al.Effect of intraarterial papaverine or nimodipine on vessel diameter in patients with cerebral vasospasm after subarachnoid hemorrhage[J].Br J Neurosurg,2012,26(4):517.
[9]Dorhout SM,Rinkel GJ,Feigin VL,et al.Calcium antagonists for aneurysmal subarachnoid hemorrhage[J].Cochrane Database Syst Rev,2007,18(3):CD000277.
[10]Charpentier C,Audibert G,Guillemin F,et al.Multivariate analysis of predictors of cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage[J].Stroke,1999,30(7):1402.
[11]Reilly C,Amidei C,Tolentino J,et al.Clot volume and clearance rate as independent predictors of vasospasm after aneurysmal subarachnoid hemorrhage[J].J Neurosurg,2004,101(2):255.
[12]Pluta RM.Delayed cerebral vasospasm and nitric oxide:review,new hypothesis,and proposed treatment[J].Pharmacol Ther,2005,105(1):23.
[13]Claassen J,Bernardini GL,Kreiter K,et al.Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage:the Fisher scale revisited[J].Stroke,2001,32(9):2012.
[14]Macdonald RL,Rosengart A,Huo D,et al.Factors associated with the development of vasospasm after planned surgical treatment of aneurysmal subarachnoid hemorrhage[J].J Neurosurg,2003,99(4):644.
[15]Mc Girt MJ,Mavropoulos JC,Mc Girt LY,et al.Leukocytosis as an independent risk factor for cerebral vasospasm following aneurysmal subarachnoid hemorrhage[J].J Neurosurg,2003,98(6):1222.
[16]陈高,张建民,李珉,等.动脉瘤性SAH继发重度脑血管痉挛相关因素研究[J].中华神经外科杂志,2005,21(11):665.
[17]Bonliha L,Marques EL,Carelli EF,et al.Risk factor and outcome in 100 patients with aneurysmal subarachnoid hemorrhage[J].Arq Neuropsiquiatr,2001,59(3-B):676.
基本信息:
DOI：10.19577/j.cnki.issn10074406.2015.01.002
中图分类号:R743.3
引用信息:
[1]赵元元,徐建林,楼林.前列地尔联合尼莫地平预防动脉瘤性蛛网膜下腔出血后症状性脑血管痉挛的疗效[J].中国临床药学杂志,2015,24(01):4-8.DOI:10.19577/j.cnki.issn10074406.2015.01.002.
2015-01-25
2015-01-25