尼莫地平治疗下TCD评估脑动脉瘤术后脑血管痉挛的效果研究  

Evaluation of cerebral vasospasm after cerebral aneurysm surgery by TCD under nimodipine treatment

作　　者：蒋健 唐智勇 周鹏 熊清源 胡昶 JIANG Jian;TANG Zhiyong;ZHOU Peng;XIONG Qingyuan;HU Chang(Department of Neurology,Yongzhou Central Hospital,Yongzhou 425000,China)

机构地区：[1]永州市中心医院神经内科,湖南永州425000

出　　处：《延边大学医学学报》2025年第1期70-72,共3页Journal of Medical Science Yanbian University

基　　金：永州市2021年度指导性科技计划项目(编号:2021-YZKJZD-028)。

摘　　要：目的:探讨尼莫地平治疗下经颅多普勒超声(TCD)评估脑动脉瘤术后脑血管痉挛(CVS)的效果。方法:选取2021年10月至2024年2月在永州市中心医院开展经皮动脉插管脑血管造影术(DSA)的100例患者作为研究对象,随机分为两组,观察组(n=50)使用尼莫地平,对照组(n=50)未使用尼莫地平。对比两组应用TCD测定的脑中动脉血流速度(MCV)和血清促红细胞生成素(EPO)水平。根据术后监测的结果,将患者分为发生CVS组(MCV>120 cm/s)和未发生CVS组(MCV≤120 cm/s)两组,以对比尼莫地平的疗效。结果:观察组在术后24 h、96 h、1周、2周时的MCV值均高于对照组(P<0.05)。在术后2周时,观察组EPO水平升高(P<0.05),MCV值降低(P<0.05)。在术后24 h、96 h、1周和2周,CVS组患者血清EPO水平均显著低于非CVS组(P<0.05),表明EPO水平与CVS的发生可能存在相关性。在术后24 h、96 h和1周时,血清EPO水平与CVS程度呈负相关(P<0.05)。在术后2周时,血清EPO水平与CVS程度无相关性(P>0.05)。结论:尼莫地平可能通过调节血流速度对CVS有预防作用。对脑动脉瘤手术患者可开展TCD检查,以评估其发生CVS的风险。Objective:To explore the effect of transcranial Doppler ultrasound(TCD)evaluation of cerebral vasospasm(CVS)after cerebral aneurysm surgery under the treatment of nifedipine.Methods:100 patients who underwent percutaneous arterial catheterization digital subtraction angiography(DSA)at Yongzhou Central Hospital from October 2021 to February 2024 were selected and randomly divided into an observation group and a control group,with 50 patients in each group.The observation group was treated with nifedipine,while the control group did not use nifedipine.The middle cerebral artery(MCV)blood flow velocity and serum erythropoietin(EPO)levels measured by TCD between two groups were compared.According to the postoperative monitoring results,patients were divided into CVS group(MCV>120 cm/s)and non-CVS group(MCV≤120 cm/s)to compare the efficacy of nifedipine.Results:The MCV values of the observation group were higher than those of the control group at 24 hours,96 hours,1 week,and 2 weeks after surgery(P<0.05).The EPO level of the observation group increased and the MCV value decreased at 2 weeks after surgery(P<0.05).At 24 hours,96 hours,1 week,and 2 weeks after surgery,the serum EPO levels in the CVS group were significantly lower than those in the non-CVS group(P<0.05),indicating a possible correlation between EPO levels and the occurrence of CVS.At 24 hours,96 hours,and 1 week after surgery,serum EPO levels were negatively correlated with the degree of CVS(P<0.05).At 2 weeks after surgery,there was no correlation between serum EPO levels and CVS severity(P>0.05).Conclusion:Nimodipine may have a preventive effect on CVS by regulating blood flow velocity.TCD examination can be performed on patients undergoing cerebral aneurysm surgery to assess their risk of developing CVS.

关 键 词：脑动脉瘤 脑血管痉挛 尼莫地平 经颅多普勒超声 脑中动脉血流速度 促红细胞生成素 

分 类 号：R743[医药卫生—神经病学与精神病学]