脑池内灌注尼莫地平治疗蛛网膜下腔出血后脑血管痉挛的疗效分析  

Curative Effectiveness of Nimodipine Perfusion at the Cistern in the Treatment of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage

作　　者：陈劲草[1] 夏涛[1] 刘斌[1] 李正伟[1] 冯雨[1] 王在贵[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《华中科技大学学报（医学版）》2009年第3期317-320,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：湖北省自然科学基金资助项目(No.2001ABB150)

摘　　要：目的观察尼莫地平脑池局部给药治疗蛛网膜下腔出血后脑血管痉挛的疗效。方法动脉瘤性蛛网膜下腔出血的患者,随机分为脑池局部给药组和静脉给药组,通过经颅多普勒检测两种给药方式治疗脑血管痉挛后脑血流速度的变化,评价脑池局部给药的疗效。结果脑池局部给药组手术后7d内脑血流速度与术前相比没有明显的变化,且全身血压没有受到影响。静脉给药组术后3d内脑血流速度比术前加快,4d以后脑血流速度逐渐恢复正常。静脉给药组术后发生了低血压反应。结论尼莫地平脑池内给药治疗脑血管痉挛的疗效优于静脉给药,且没有全身低血压反应的发生。Objective To explore the curative effectiveness of nimodipine perfusion at the cistern in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage （SAH）. Methods Thirty-one patients with aneurysmal SAH were randomly assigned to two groups. The patients were continuously infused with the diluted nimodipine injection into the cisterna via a rubber tube over a period of 7 days after surgery as cisterna perfusion group, and those were administered with the nimodipine injection by intravenous injection over a period of 7 days after surgery as intravenous injection group. Before and after operation, the blood flow velocity of middle cerebral artery （MCA） was measured by transcranial Doppler in two groups before and after operations. Results In cisterna perfusion group, there was no significant difference in blood flow velocity and blood pressure before and after operations. In intravenous injection group, blood flow velocity, during a period of 3 days after operation, was faster than that before operation; Four days after operation, the blood flow velocity returned to normal; Hypotension occurred after operation. Conclusion Perfusion with the nimodipine injection at the cisterna can significantly alleviate cerebral vasospasm, and no systemic hypotension occurred after operation, suggesting this application is more effective than intravenous injection.

关 键 词：尼莫地平 蛛网膜下腔出血 脑血管痉挛 经颅多普勒 

分 类 号：R743.35[医药卫生—神经病学与精神病学]