动脉内超选滴注法舒地尔治疗症状性脑血管痉挛疗效分析  

Superselective intra-arterial infusion of fasudil for the treatment of symptomatic cerebral vasospasm:curative effect analysis

作　　者：贺西亮 潘源[1] 卢佩林[1] 辛涛[1] 汪凯[1] 邵铂添 姜绪涛[1] 于召虎 

机构地区：[1]解放军第401医院神经外科,山东青岛266071

出　　处：《介入放射学杂志》2015年第10期846-848,共3页Journal of Interventional Radiology

基　　金：青岛市民生计划项目(131352nsh)

摘　　要：目的探讨动脉内超选滴注法舒地尔结合常规抗血管痉挛法治疗症状性脑血管痉挛（SCVS）即时临床效果。方法回顾性分析2010年5月至2014年2月动脉瘤性蛛网膜下腔出血患者21例（FisherII级2例、Ⅲ级16例、Ⅳ级3例）。全脑血管DSA造影确诊颅内动脉瘤并于发病48h内行血管内栓塞动脉瘤，术中无出血．给予常规抗血管痉挛治疗。发病4～9d内21例患者均出现SCVS，遂行超选动脉内半量全身肝素化，持续30min滴注法舒地尔（30mg加250ml生理盐水），滴注后15rain造影复查并对照分析给药前后美国国立卫生研究院卒中量表（NIHSS）评分。结果术后影像学显示显著改善15例，无明显变化6例；临床症状显著改善11例，部分改善4例，无变化6例。NIHSS评分由治疗前平均28．6分改善为治疗15min后平均21.2分。结论动脉内超选滴注法舒地尔治疗SCVS起效迅速、安全有效．有较好的临床应用价值。Objective To investigate the instant clinical efficacy of intra-arterial infusion of fasudil combined with routine anti-vasospasm for symptomatic cerebral vasospasm （SCVS）. Methods The clinical data of 21 patients with subarachnoid hemorrhage （SAH） due to ruptured aneurysm, who were admitted to authors＇ hospital during the period from May 2010 and February 2014, were retrospectively analyzed. The lesions included Fisher grade Ⅱ （n=2）, grade Ⅲ （n=16） and grade IV （n=3）. Endovascular embolization of the aneurysm was carried out within 48 hours after the confirmation of the diagnosis with total cerebral DSA; no bleeding occurred during the operation and routine anti-vasospasm therapy was given. Within 4-9 days after the onset of the disease, all 21 patients presented SCVS. Half dose systemic heparinization, superselective intra-arterial infusion of fasudil （30 mg fasudil＋250 ml saline, lasting for 30 min） were adopted. Reexamination of angiography performed at 15 min after fasudil infusion was employed, and the results were evaluated with NIHSS score by comparing the preoperative findings. Results Imaging examination performed after the treatment showed that significant improvement was obtained in 15 patients and no obvious changes in 6 patients. Clinical symptoms were remarkably improved in 11 patients, partially improved in 4 patients and remained unchanged in 6 patients. The mean NIHSS score was improved from preoperative 28.6 to postoperative 21.2. Conclusion For the treatment of symptomatic cerebral vasospasm, superselective intra-arterial infusion of fasudil is effective and safe, and it has good clinical application value.

关 键 词：法舒地尔 脑血管介入 脑血管痉挛 

分 类 号：R743[医药卫生—神经病学与精神病学]