经动脉灌注尼莫地平治疗蛛网膜下腔出血后脑血管痉挛  

Treatment of cerebral vasospasm after subarachnoid hemorrhage by intra arterial infusion of nimodipine

作　　者：斯良楠[1] 孙晓川[1] 张晓冬[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400042

出　　处：《中国介入影像与治疗学》2015年第9期527-531,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：重庆市医学科研计划项目(2010-2-068)

摘　　要：目的探讨脑动脉瘤介入术后,经动脉内灌注尼莫地平(IAN)治疗蛛网膜下腔出血(SAH)后症状性脑血管痉挛的安全性及有效性。方法将62例SAH伴症状性脑血管痉挛患者随机分为干预组(n=37)和对照组(n=25)。干预组:在动脉瘤介入栓塞后,经颈内动脉灌注2.0mg IAN;对照组:经颈内动脉灌注10ml生理盐水。在动脉内灌注治疗前后,均行脑血管DSA。测量并计算脑循环时间(CCT)、末端周围循环的CCT(peri-CCT)、目标血管直径。对比两组患者出院时的格拉斯哥预后(GOS)评分。结果对照组:给药前后CCT值及peri-CCT值差异均无统计学意义(P均>0.05),M1段血管直径略有减少,但与给药前的差异无统计学意义(P>0.05);A1段血管直径减少,与给药前差异有统计学意义(t=-2.37,P=0.045);M4段血管直径减少,与给药前的差异有统计学意义(t=-3.50,P=0.008)。干预组:给药后CCT值及peri-CCT值较治疗前明显缩短,差异均有统计学意义(P均<0.05),大脑中动脉M1段、大脑前动脉A1段、大脑中动脉M4段血管直径分别增加了(7.18±2.47)%、(6.78±4.35)%、(16.84±10.00)%(P均<0.05)。两组患者出院时的GOS差异无统计学意义(χ2=0.094,P=0.760)。结论动脉瘤介入栓塞术后,予以IAN治疗,可在一定程度上舒张脑血管并改善脑微循环,但对最终临床预后影响不大。Objective To evaluate the safety and effectiveness of intra-arterial administration of nimodipine （IAN） for treating symptomatic cerebral vasospasms （CVS） after subarachnoid hemorrhage （SAH）. Methods A total of 62 patients with symptomatic vasospasms due to SAH accepted endovascular treatment of cerebral aneurysms, were divided randomly into two groups, as control group （n=25） and interventional group （n= 37）. In control group, 10 ml physiologic saline were infused after embolization of cerebral aneurysm. In interventional group, 2.0 mg nimodipine were infused after embolization of cerebral aneurysm. DSA were performed respectively before and after intra-arterial administration of nimodipine or physiologic saline in the 62 patients. Cerebral circulation time （CCT）, peripheral CCT, and the diameters of interest ar- teries （M1, A1,. M4） were calculated. The differences of Glasgow outcome scale （GOS） between the two groups were compared. Results In control group, CCT and peripheral CCT did not show significant differences between pre- and post- treatment. The M1 segment of middle cerebal artery diameter slightly reduced after IAN, but there were no statistical differences. The A1 segment of anterior cerebral artery diameter （t=- 2.37, P= 0. 045） and M4 segment of middle cere- bral artery diameter （t=- 3.50, P=0. 008） reduced after IAN significantly. In interventional group, CCT and peripheral CCT significantly reduced after IAN （both P〈0.05）; the M1, A1, M4 segment artery diameter increased by （7.18±2. 47） %, （6.78±4. 35）%, （16.84±10.00）% after IAN. The differences of GOS between the contol group and interven- tional group were not significant （X2 = 0. 094, P〈 0. 760）. Conclusion The spastic arteries and cerebral microcirculation were relaxed but the clinical outcome of SAH patients were not improved after the treatment of IAN.

关 键 词：蛛网膜下腔出血 脑血管痉挛 脑循环时间 动脉内灌注 尼莫地平 

分 类 号：R743.35[医药卫生—神经病学与精神病学]