摘要
目的探讨经动脉局部灌注尼莫地平防治动脉瘤性蛛网膜下腔出血(aSAH)后脑血管痉挛(CVS)的可行性,以减少CVS的发生,降低致残率、病死率。方法 33例病人随机分为2组,治疗组17例常规静脉及口服尼莫地平治疗,同时栓塞治疗术后保留动脉鞘,利用单弯导管分别经双侧颈内动脉灌注尼莫地平,总量20mg,持续20h。对照组16例常规静脉及口服尼莫地平治疗。利用TCD探测2组患者栓塞术前及术后1d、3d、7d、14d5个时间点双侧大脑中动脉平均血流速度(Vm-MCA),以了解脑血管痉挛情况。结果 2组病人在术后1d、3d、7d探测的Vm-MCA具有显著差异,经动脉局部灌注尼莫地平治疗组CVS发生率明显低于对照组。结论 对于Hunt-Hess分级Ⅲ级、Ⅳ级,前循环动脉瘤破裂出血的重症患者,经动脉局部灌注尼莫地平对降低aSAH后CVS的发生率有效。
Objective To explore the feasibility of prevention of CVS of aSAH through artery local perfusion nimodopine,in order to reduce deformity rate and mortality.Methods Thirty-three cases were divided into two groups by random.The therapy group（17 cases） was treated through elbowed catheter to both internal carotid local perfusion nimodipine 20 mg for 20 hours after embolism and reserving artery sheath,besides routine treatment with nimodipine by vein and taking orally.The control group（16 cases） was treated with routine nimodipine by vein and taking orally.Two groups were checked the Vm-MCA by TCD before embolism and after embolism of 1 day,3 days,7 days and 14 days,in order to diagnose the degree of CVS.Results There was distinct difference between two groups after embolism of 1 day,3 days and 7 days.The incidence rate of CVS of therapy group was lower than the control group.Conclusion The treatment of artery local perfusion nimodopine can reduce CVS of aSAH in Hunt-Hess Ⅲ or Ⅳ degree severe cases of aneurism broken of former Willis circle,the treatment is feasible.
出处
《中国实用神经疾病杂志》
2012年第8期11-14,共4页
Chinese Journal of Practical Nervous Diseases
