尼莫地平和丁苯酞治疗后动脉瘤性蛛网膜下腔出血患者血管痉挛的时间演变和临床结局  

Time evolution and clinical outcomes of vasospasm in patients with aneurysmal subarachnoid hemorrhage treated with nimodipine and butylphthalide

作　　者：陈焕磊 张根堂 匡荣岩 刘京平 刘文涛 CHEN Huanlei;ZHANG Gentang;KUANG Rongyan;LIU Jingping;LIU Wentao(Jiaozhou Central Hospital of Qingdao,Qingdao 266300,China)

机构地区：[1]青岛市胶州中心医院,山东青岛266300

出　　处：《中国实用神经疾病杂志》2024年第6期720-726,共7页Chinese Journal of Practical Nervous Diseases

基　　金：青岛市医药卫生科研计划项目(编号:2021-WJZD126)。

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血(aSAH)患者采用尼莫地平和丁苯酞(NBP)治疗后血管痉挛(CVS)的时间演变和临床结局。方法招募2021-05—2022-05入住胶州中心医院神经重症监护室的aSAH患者100例,均在颅内动脉瘤栓塞术后14 d内出现CVS。通过抽签随机分为2组,每组50例,对照组患者静脉注射尼莫地平,观察组患者联合静脉输注NBP,持续7 d。主要终点在aSAH后90 d评估Glasgow预后评分(GOS),分为良好(≥4分)或差(<4分)结局。次要终点评估CVS随时间演变的趋势、CVS相关梗死、院内全因病死率。结果主要终点:2组出院时、30 d和90 d GOS评分均无统计学差异(P>0.05)。与对照组(62.0%)患者相比,90 d时观察组患者恢复良好(GOS评分≥4分)的比例更高(80.0%),差异有统计学意义(P=0.047)。次要终点:对照组4例(8.0%)和观察组1例(2.0%)患者院内死亡(RR=0.235,P=0.202,95%CI:0.025~2.178)。对照组30.0%(15/50)和观察组16.0%(8/50)的患者有延迟性CVS相关新发脑梗死(RR=0.370,P=0.041,95%CI:0.142~0.962)。随访大脑中动脉(MCA)经颅多普勒超声(TCD)的血流量,从输注前第2天(D-2天)到输注前(D-1天),2组患者MCA血流量测量值均增加,包括平均和最大峰值收缩流速(PSV)及平均流速(MFV)。MCA血流量的所有测量在D-1天和输注后(D1天)间无统计学差异(P>0.05),但从D2天开始,观察组最大PSV和MFV一直低于对照组(P<0.05),D2~D5天观察组平均PSV和MFV也低于对照组(P<0.05)。结论尼莫地平联合NBP治疗对改善aSAH患者临床结果有显著益处,且价格低,可在临床上广泛应用。Objective To investigate the time evolution and clinical outcome of cerebral vasospasm(CVS)in patients with aneurysmal subarachnoid hemorrhage(aSAH)after nimodipine and butylphthalide(NBP)treatment.Methods A total of 100 patients with aSAH admitted to the Neurological Intensive Care Unit of Jiaozhou Central Hospital from May 2021 to May 2022 were prospectively recruited.These patients developed CVS within 14 days after embolization of intracranial aneurysms.The patients were randomly divided into two groups by drawing lots,with 50 cases in each group,the control group received intravenous nimodipine,and the observation group received combined intravenous NBP for 7 days.The primary endpoint was assessed by the Glasgow outcome scoale(GOS)at 90 days after aSAH,with good(GOS≥4)or poor(GOS<4)outcome.Secondary endpoints assessed trends in CVS over time,CVS-associated infarction,and in-hospital all-cause mortality.Results Primary endpoint:there were no significant differences in GOS scores at discharge,30-day and 90-day between two groups(P>0.05).However,compared with the control group(62.0%),the proportion of patients in the observation group with good recovery(GOS score≥4 points)at 90-day was higher(80.0%)and reached statistical significance(P=0.047).Secondary endpoints:4(8.0%)patients in the control group and 1(2.0%)patient in the observation group died in hospital(RR=0.235,P=0.202,95%CI:0.025-2.178).Patients in the control group(30.0%(15/50))and observation group(16.0%(8/50))had delayed CVS-related new cerebral infarction(RR=0.370,P=0.041,95%CI:0.142-0.962).Median cerebral artery(MCA)transcranial Doppler ultrasound(TCD)blood flow data were followed from day 2(D-2)before infusion to 1(pre-infusion),and both MCA blood flow measurements increased,including mean and maximum peak systolic flow velocity(PSV)and mean flow velocity(MFV).All measures of MCA blood flow did not differ between day D-1(before infusion)and D1(after infusion)(P>0.05),but the maximum PSV and MFV of the observation group were consistently lower

关 键 词：动脉瘤性蛛网膜下腔出血 脑梗死 尼莫地平 丁苯酞 血管痉挛 经颅多普勒超声 

分 类 号：R743.35[医药卫生—神经病学与精神病学]