动脉内灌注维拉帕米与尼卡地平治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛的疗效比较  

Efficacy Comparison of Intra-arterial Infusion of Verapamil and Nicardipine in Treatment of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage

作　　者：陈永军 冯文 CHEN Yongjun;FENG Wen(Department of Neurosurgery,363 Hospital,Chengdu 610041,China)

机构地区：[1]三六三医院神经外科,成都610041

出　　处：《医学综述》2020年第12期2484-2488,共5页Medical Recapitulate

摘　　要：目的比较动脉内灌注维拉帕米与尼卡地平治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛(CVS)的临床疗效。方法回顾性分析2018年4月至2019年2月三六三医院神经外科确诊的动脉瘤性蛛网膜下腔出血后67例CVS患者的临床资料,所有患者均接受颅内动脉瘤开颅夹闭治疗,根据动脉内灌注用药不同分为两组,对照组(30例)采用微导管超选择至痉挛动脉并灌注尼卡地平,观察组(37例)选择性灌注维拉帕米。比较两组患者的临床疗效,治疗前后脑血流速度、平均动脉压、心率、心搏指数以及预后情况。结果观察组总有效率高于对照组[97. 30%(36/37)比76. 67%(23/30)](P <0. 01)。治疗第1天、治疗第3天、治疗第7天,两组双侧大脑中动脉平均血流速度均呈先升高后降低的趋势,观察组各时点间均慢于对照组(P <0. 05)。治疗第7天,两组平均动脉压、搏动指数均低于治疗前,观察组低于对照组(P <0. 05);心率的组间、时点间、组间和时点间交互作用比较差异无统计学意义(P> 0. 05)。观察组的预后良好率高于对照组[91. 89%(34/37)比66. 67%(20/30)](P <0. 05)。结论动脉内灌注维拉帕米治疗动脉瘤性蛛网膜下腔出血后CVS,可有效改善患者脑血流动力学,且安全可靠,不影响心率水平,预后良好。Objective To compare the clinical efficacy of intra-arterial infusion of verapamil and nicardipine in the treatment of cerebral vasospasm(CVS)after aneurysmal subarachnoid hemorrhage.Methods The clinical data of 67 patients with CVS after aneurysmal subarachnoid hemorrhage confirmed by the Department of Neurosurgery,363 Hospital from Apr.2018 to Feb.2019,who were all treated with intracranial aneurysm clipping were retrospectively analyzed,and were divided into a control group and an observation group according to the different intra-arterial perfusion drugs:30 patients in the control group were given nicardipine at the spasmodic artery approached by superselective microchannel,while 37 patients in the observation group were given selective perfusion of verapamil.The curative effect,cerebral blood flow velocity,blood pressure,heart rate,cardiac index and prognostic effect of the two groups were compared.Results The total effective rate of the observation group was higher than that of the control group[97.30%(36/37)vs 76.67%(23/30)](P<0.01).On the first day,the third day of treatment,and the seventh day of treatment,the average blood flow velocity of both middle cerebral arteries of the two groups showed a trend of first increasing and then decreasing,and the observation group was lower than the control group at each time point(P<0.05).On the 7th day of treatment,the average arterial pressure and pulsatility index of the two groups were lower than before treatment,and the observation group was slower than the control group(P<0.05);the heart rate was not statistically different between the groups,between the time points,and between interactions of the groups and time points(P>0.05).The good prognosis rate of the observation group was higher than that of the control group[91.89%(34/37)vs 66.67%(20/30)](P<0.05).Conclusion Intra-arterial infusion of verapamil can be used in patients with CVS after aneurysmal subarachnoid hemorrhage,which can effectively improve the cerebral hemodynamics,with good safety and reliabilit

关 键 词：动脉瘤性蛛网膜下腔出血 动脉内灌注维拉帕米 血流动力学 格拉斯哥预后评分 

分 类 号：R543.1[医药卫生—心血管疾病]