尼莫地平联合持续腰大池引流防治动脉瘤性蛛网膜下腔出血术后脑血管痉挛的效果  

Efficacy of nimodipine combined with continuous lumbar cistern drainage in preventing cerebral vasospasm after aneurysmal subarachnoid hemorrhage surgery

作　　者：杨正刚[1] YANG Zhenggang(Songzi People′s Hospital,Hubei Province,Songzi 434200,China)

机构地区：[1]湖北省松滋市人民医院,434200

出　　处：《临床合理用药》2025年第9期18-21,26,共5页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的观察尼莫地平联合持续腰大池引流防治动脉瘤性蛛网膜下腔出血术后脑血管痉挛的效果。方法回顾性选取2021年8月—2023年8月松滋市人民医院收治的动脉瘤性蛛网膜下腔出血患者68例,根据治疗用药方案不同分为试验组和对照组,每组34例。在常规治疗+持续腰大池引流基础上,试验组应用尼莫地平注射液治疗,对照组应用盐酸维拉帕米注射液治疗,2组均用药治疗1周。比较2组临床疗效,治疗1、2周后脑血管痉挛程度,治疗前与治疗2周后脑血流动力学指标、血清学指标。结果试验组治疗总有效率高于对照组(97.06%vs.76.47%,χ^(2)=4.610,P=0.032)。治疗1周后,2组无痉挛、轻度痉挛、重度痉挛患者占比比较,差异无统计学意义(P>0.05),试验组中度痉挛患者占比低于对照组(14.71%vs.38.24%,χ^(2)=4.836,P=0.028);治疗2周后,试验组无痉挛患者占比高于对照组(55.88%vs.26.47%,χ^(2)=6.071,P=0.014),中度痉挛患者占比低于对照组(0 vs.20.59%,χ^(2)=5.733,P=0.017),2组轻度痉挛、重度痉挛患者占比比较,差异无统计学意义(P>0.05)。治疗2周后,2组脑血容量、脑血流量较治疗前增加,对比剂达峰时间、对比剂平均通过时间较治疗前缩短,且试验组增加/缩短幅度大于对照组(P<0.01);2组血清基质金属蛋白酶-9、S-100钙结合蛋白B、可溶性细胞间黏附分子-1及可溶性血管细胞黏附分子-1水平较治疗前下降,且试验组低于对照组(P<0.01)。结论相较于维拉帕米,尼莫地平联合持续腰大池引流防治动脉瘤性蛛网膜下腔出血术后脑血管痉挛的效果更为显著,可减轻患者脑血管痉挛程度,改善脑部血液循环,避免脑损伤加重。Objective To observe the efficacy of nimodipine combined with continuous lumbar cistern drainage for the prevention of cerebral vasospasm following aneurysmal subarachnoid hemorrhage surgery.Methods Sixty-eight patients with aneurysmal subarachnoid hemorrhage admitted to Songzi People′s Hospital from August 2021 to August 2023 were retrospectively selected,and they were divided into the experimental group and the control group according to different treatment regimens,with 34 cases in each group.On the basis of operation+routine treatment+continuous lumbar cistern drainage,the experimental group was treated with nimodipine injection,and the control group was treated with verapamil hydrochloride injection.Both groups were treated with drugs for 1 week.The clinical efficacy,the degree of cerebral vasospasm after 1 and 2 weeks of treatment,the indexes of cerebral hemodynamics and serology before and after 2 weeks treatment were compared between the two groups.Results The total effective rate in the experimental group was higher than that in the control group(97.06%vs.76.47%,χ^(2)=4.610,P=0.032).After 1 week of treatment,there was no significant difference in the proportion of patients with no spasm,mild spasm and severe spasm between the two groups(P>0.05),and the proportion of patients with moderate spasm in the experimental group was lower than that in the control group(14.71%vs.38.24%,χ^(2)=4.836,P=0.028).After 2 weeks of treatment,the proportion of patients without spasm in the experimental group was higher than that in the control group(55.88%vs.26.47%,χ^(2)=6.071,P=0.014),and the proportion of patients with moderate spasm was lower than that in the control group(0 vs.20.59%,χ^(2)=5.733,P=0.017).There was no significant difference in the proportion of patients with mild spasm and severe spasm between the two groups(P>0.05).After 2 weeks of treatment,the cerebral blood volume and cerebral blood flow in the two groups were increased compared with those before treatment,and the peak time and average passage

关 键 词：动脉瘤性蛛网膜下腔出血 脑血管痉挛 尼莫地平 手术治疗 持续腰大池引流 

分 类 号：R74[医药卫生—神经病学与精神病学]