介入栓塞后尼莫地平动脉内灌注治疗动脉瘤性蛛网膜下腔出血后症状性脑血管痉挛患者的临床研究  

Clinical trial of intra-arterial nimodipine perfusion after interventional embolization in the treatment of patients with symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage

作　　者：钱金明 张潜 岳培东 QIAN Jin-ming;ZHANG Qian;YUE Pei-dong(Department of Neurosurgery,Suzhou Hospital Affiliated to Anhui Medical University,Suzhou Municipal Hospital,Anhui Province,Suzhou 234000,Anhui Province,China)

机构地区：[1]安徽医科大学附属宿州医院、安徽省宿州市立医院神经外科,安徽宿州234000

出　　处：《中国临床药理学杂志》2024年第3期325-329,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的 观察介入栓塞术后尼莫地平动脉内灌注治疗动脉瘤性蛛网膜下腔出血(aSAH)后症状性脑血管痉挛(SCVS)的效果,并探讨其对血管内皮功能的影响。方法 将aSAH后SCVS患者按队列法分为试验组和对照组。2组均在对症支持治疗的基础上开展介入栓塞术,术后给予稀释血液、扩容和升压等常规3 H治疗,试验组另加用尼莫地平动脉内灌注,用电子泵经股动脉血管鞘以0.2 mg·min^(-1)注射20%尼莫地平,每次2 mg,每天1次,用药7 d后拔除血管鞘改为尼莫地平片口服,每次60~120 mg,每日2次于餐后服用。2组疗程均为14 d。比较2组患者的脑血管血流速度、实验室指标、术后并发症和预后情况。结果 试验组41例和对照组38例。试验组和对照组治疗2周时大脑前动脉(ACA)平均血流速度分别为(84.32±5.27)和(93.46±5.61)cm·s^(-1),大脑中动脉(MCA)平均血流速度分别为(86.05±5.94)和(95.23±6.37)cm·s^(-1),大脑后动脉(PCA)平均血流速度分别为(59.41±4.82)和(71.56±5.39)cm·s^(-1),在统计学上差异均有统计学意义(均P<0.05);试验组和对照组治疗2周时血清内皮素-1(ET-1)分别为(76.32±10.58)和(94.16±10.98)pg·mL^(-1),血管内皮细胞生长因子(VEGF)分别为(127.45±14.83)和(164.85±15.62)ng·mL^(-1),可溶性Fms酪氨酸激酶1(sFlt-1)分别为(103.67±15.34)和(114.98±16.43)ng·L^(-1),血浆可溶性细胞间黏附分子-1(sCAM-1)分别为(234.81±62.79)和(285.36±90.24)ng·mL^(-1),缺氧诱导因子2α(HIF-2α)分别为(98.74±7.56)和(102.49±8.35)pg·mL^(-1),血清一氧化氮(NO)分别为(43.16±4.91)和(39.72±5.37)mmol·L^(-1),在统计学上差异均有统计学意义(均P<0.05)。试验组术后迟发性脑血管痉挛(DCVS)和脑积水发生率分别为4.88%和9.76%,均显著低于对照组的21.05%和28.95%,在统计学上差异均有统计学意义(均P<0.05);试验组术后3个月时格拉斯哥预后量表(GOS)评分5分患者占比为78.05%,显著高于对照组的55.26%,在统计学上�Objective To observe the effect of intra-arterial nimodipine perfusion after interventional embolization in the treatment of symptomatic cerebral vasospasm (SCVS) after aneurysmal subarachnoid hemorrhage (a SAH) and explore its influence on vascular endothelial function.Methods Patients with SCVS after a SAH were divided into treatment group and control group according to cohort methods.Both groups received interventional embolization based on symptomatic supportive treatment,and were given conventional 3H treatments such as blood dilution,dilatation and pressure enhancement after surgery,and the treatment group was additionally given intra-arterial perfusion of nimodipine(20%nimodipine was injected by electronic pump through the femoral artery sheath at a rate of 0.2 mg·min^(-1)for 2mg once a day,vascular sheath was removed and nimodipine tablet after 7 days of medication was taken orally for 60-120 mg twice a day after meals),and both groups were treated for 14 days.The cerebrovascular blood flow velocity,laboratory indicators,postoperative complications and prognosis were compared between the two groups.Results There were 41 cases in treatment group,and 38 cases in control group.After 2 weeks of treatment,the average blood flow velocities of anterior cerebral artery (ACA) in treatment group and control group were (84.32±5.27) and(93.46±5.61) cm·s^(-1),the average blood flow velocities of middle cerebral artery (MCA) were (86.05±5.94)and (95.23±6.37) cm·s^(-1),the average blood flow velocities of posterior cerebral artery (PCA) were(59.41±4.82) and (71.56±5.39) cm·s^(-1)respectively (all P<0.05).The levels of serum endothelin-1(ET-1) in treatment group and control group after 2 weeks of treatment were (76.32±10.58) and (94.16±10.98)pg·m L^(-1);the levels of vascular endothelial growth factor (VEGF) were (127.45±14.83) and (164.85±15.62)ng·m L^(-1);the levels of soluble fms-like tyrosine kinase-1 (s Flt-1) were (103.67±15.34) and(114.98±16.43) ng·L^(-1);the levels of plasma soluble intercellul

关 键 词：尼莫地平 颅内动脉瘤 蛛网膜下腔出血 脑血管痉挛 介入栓塞术 动脉内灌注 

分 类 号：R972[医药卫生—药品]