超选择性动脉内灌注罂粟碱治疗动脉瘤夹闭术后症状性脑血管痉挛  

Intra-arterial infusion of papaverine for symptomatic cerebral vasospasm after aneurysm clipping

作　　者：冯东侠[1] 周新民[1] 徐卫东[1] 高恒[1] 

机构地区：[1]东南大学微侵袭神经外科研究所,江苏江阴214400

出　　处：《中国脑血管病杂志》2007年第6期250-253,共4页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的研究超选择性动脉内灌注罂粟碱治疗颅内动脉瘤夹闭术后症状性脑血管痉挛的疗效。方法25例颅内动脉瘤夹闭术后患者均在临床症状明显恶化后8h内接受28次动脉内罂粟碱灌注。其中在颈内动脉床突上段灌注10次，颈内动脉海绵窦段灌注5次，ACAAI段灌注5次，MCAMI段灌注5次，基底动脉灌注3次，采用质量分数为0．4％的罂粟碱溶液，用微量泵以2-4ml／min的速度动脉内缓慢注入，每支动脉罂粟碱注入量〈200mg，每次灌注总量〈600mg。采用经颅多普勒超声（TCD）评估治疗前、后痉挛严重侧MCA平均血流速度变化，采用Barrel指数对治疗前、后临床状况进行评估。结果治疗后23例患者（92％）经脑血管造影发现原痉挛血管明显扩张，TCD显示治疗前、后MCA平均血流速度由（192±4）cm／s降至（138±4）cm／s（P〈0．05），术后意识、肢体活动和语言功能明显改善者21例（84％），治疗前Barrel指数为（29±6），治疗后为（49±7），P〈0．05。在颈内动脉局部灌注中，行反复血管内治疗3例，发生低血压1例；在基底动脉灌注时，出现瞳孔散大1例，发生短暂性脑干功能抑制1例。结论超选择性动脉内灌注罂粟碱治疗严重的症状性脑血管痉挛疗效良好，但必须注意控制药物剂量和输注速度，以避免出现严重的并发症。Objective To study the efficacy of intra-arterial infusion of papaverine in the treatment of symptomatic cerebral vasospasm after aneurysm clipping. Methods A total of 25 patients whose intracranial aneurysms were clipped, were treated within 8 hours after their clinical symptoms had deteriorated remarkably, and papaverine infusions were performed on 28 occasions, in which the supraclinoid internal carotid artery （ 10 times）, the cavernous sinus segment of internal carotid artery （5 times）, AI segment of anterior cerebral artery （5 times） , MI segment of middle cerebral artery （5 times）, and basilar artery （3 times） were infused. The concentration of papaverine solution was 0. 4% （w/v）, and it was infused slowly at the rate of 2-4 ml/min with microinfusion pump. Papaverine did not exceed 200 mg in each vessel, and the total close was controlled within 600 mg. The changes of mean blood flow velocities （mBFVs） on the severe side of the middle cerebral artery were measured by transeranial Doppler sonography （TCD）, and the clinical efficacy was evaluated by Barthel index before and after the treatment. Results The previously spastic vessels in 23 patients （92%） were identified to be dilated significantly on cerebral angiography after the treatment. TCD showed that mBFVs in the middle cerebral artery decreased from （ 192 ± 4） cm/s to （ 138 ± 4） cm/s （ P 〈0. 05 ）. The consciousness, limb movement and language function improved significantly in 21 patients （ 84% ） after the procedure, and their Barthel index had increased more than 20. Three patients received repeated endovascular treatment, and one patient had systemic hypotension during the internal carotid infusion; one patient had mydriasis, and the other had transient brainstem inhibition during the basilar artery infusion. Conclusion The efficacy of superselectire intra-arterial infusion of papaverine for treatment of severe symptomatic vasospasm is obvious ; however, its dosage and rate of infusion must be c

关 键 词：血管痉挛 颅内 颅内动脉瘤 罂粟碱 

分 类 号：R743.3[医药卫生—神经病学与精神病学]