鞘内应用罂粟碱治疗动脉瘤术后症状性血管痉挛  

Intrathecal application of papaverine for the treatment of symptomatic vasospasm following ruptured intracranial aneurysms surgery

作　　者：冯东侠[1] 徐卫东[2] 周新民[2] 高恒[2] 周良辅[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040 [2]东南大学微侵袭神经外科研究所,江苏江阴214400

出　　处：《中华神经外科疾病研究杂志》2007年第2期122-124,共3页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的回顾性分析鞘内应用罂粟碱治疗破裂脑动脉瘤夹闭术后症状性血管痉挛的临床疗效。方法对于临床常规处理无效、出现进行性神经功能恶化、经颅多谱勒(TCD)检查证实存在严重脑血管痉挛的患者,在腰穿释放30ml血性脑脊液后,缓慢注入0.3%(60mg/20ml)罂粟碱溶液20ml。每次注药后行TCD动态检查以明确治疗效果。结果经鞘内灌注罂粟碱治疗,血管痉挛缓解率达90%(40/45),临床症状明显改善率达84.4%(38/45)。用药后发生一过性低血压者3例,短暂性偏瘫1例。全部患者得到随访,存在与血管痉挛相关的永久性神经功能缺损者占6.7%(3/45)。结论鞘内应用罂粟碱对大部分的症状性脑血管痉挛有效,且无明显副作用。Objective To retrospectively evaluate the efficacy of intrathecal application of papaverine for the treatment of symptomatic vasospasm after ruptured aneurysm surgery. Methods The intrathecal application of papaverine was performed for the patients presented with postoperative symptomatic vasospasm refractory to routine management. After drainage of 30 ml blood craniospinal fluid（CSF）, 20 ml papaverine with a concentration of 0. 3% was injected intrathecally. Clinical and TCD monitoring was repeatedly done to assess the therapeutic response to papaverine. Results Papaverine was very effective in decreasing the intracranial vessel velocities in 40 cases （90%）. Clinical manifestation was improved in 38 cases （84. 4% ）. One patient developed transient hypotension and another developed transient paraparesis following the use of papaverine. All patients obtained the follow-up and the persistent neurological deficits were found in 3 patients （6. 7% ）. Conclusion Intrathecal application of papaverine is a helpful treatment for reversing symptomatic vasospasm in a sizeable proportion of patients without any adverse effects.

关 键 词：罂粟碱 血管痉挛 

分 类 号：R651.122[医药卫生—外科学]