摘要
目的:探讨亚低温联合尼莫地平脑池内灌注对蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)的疗效。方法:选择2014年2月至2016年5月我院收治的SAH后CVS患者92例为研究对象。患者被随机均分为亚低温组(接受亚低温治疗)和联合治疗组(接受亚低温并尼莫地平脑池内灌注),疗程3d。观察比较两组疗效、治疗前后格拉斯哥昏迷量表(GCS)评分、大脑中动脉(MCA)平均血流速度、血清肿瘤坏死因子(TNF)-α、超敏C反应蛋白(hsCRP)、白介素6(IL-6)水平,以及不良事件发生率。结果:与治疗前比较,治疗后两组GCS评分均显著升高,MCA平均血流速度、血清TNF-α、hsCRP和IL-6水平均显著降低(P均=0.001);与亚低温组比较,联合治疗组治疗后GCS评分[(10.26±2.14)分比(12.35±2.56)分]升高更显著,MCA平均血流速度[(97.48±18.20)cm/s比(89.74±18.40)cm/s]、血清TNF-α[(0.56±0.17)ng/ml比(0.34±0.11)ng/ml]、hsCRP[(186.75±15.19)ng/L比(173.24±15.23)ng/L]和IL-6[(10.41±2.06)ng/L比(8.51±2.13)ng/L]水平降低更显著,P<0.05或<0.01。联合治疗组治疗总有效率显著高于亚低温组(91.30%比71.74%),P=0.016;不良事件发生率显著低于亚低温组(6.52%比21.74%),P=0.032。结论:亚低温治疗联合尼莫地平脑池内灌注能够有效降低大脑中动脉血流速度,减轻炎性反应,提高疗效,且不良事件少,值得推广。
Objective：To explore therapeutic effect of subhypothermia combined cisternal nimodipine perfusion（CNP）on cerebral vasospasm（CVS）after subarachnoid hemorrhage（SAH）.Methods：A total of 92 patients with CVS after SAH treated in our hospital from Feb 2014 to May 2016 were selected.The patients were randomly and equally divided into subhypothermia group（received subhypothermia treatment）and combined treatment group（received subhypothermia treatment combined CNP）,both groups were treated for 3 d.Therapeutic effect,Glasgow coma scale（GCS）score,middle cerebral artery（MCA）mean blood flow velocity,serum levels of tumor necrosis factor（TNF）-α,high sensitive C reactive protein（hsCRP）and interleukin（IL）-6 before and after treatment,and incidence rate of adverse events were compared between two groups.Results：Compared with before treatment,after treatment,there was significant rise in GCS score,and significant reductions in MCA mean blood flow velocity,serum levels of TNF-α,hsCRP and IL-6 in two groups,P=0.001 all;compared with subhypothermia group after treatment,there was significant rise in GCS score[（10.26±2.14）scores vs.（12.35±2.56）scores],and significant reductions in MCA mean blood flow velocity[（97.48±18.20）cm/s vs.（89.74±18.40）cm/s],serum levels of TNF-α[（0.56±0.17）ng/ml vs.（0.34±0.11）ng/ml],hsCRP[（186.75±15.19）ng/L vs.（173.24±15.23）ng/L]and IL-6[（10.41± 2.06）ng/L vs.（8.51±2.13）ng/L]in combined treatment group,P〈0.05 or〈0.01.Total effective rate of combined treatment group was significantly higher than that of subhypothermia group（91.30% vs.71.74%）,P=0.016;and incidence rate of adverse events was significantly lower than that of subhypothermia group（6.52% vs.21.74%）,P=0.032.Conclusion：Subhypothermia treatment combined cisternal nimodipine perfusion can effectively reduce MCA blood flow velocity,relieve inflammation and improve therapeutic effect with less adverse events,which is worth extending.
作者
周刚
王佳君
ZHOU Gang, WANG Jia-jun(Department of Neurology, Central Hospital of Huanggang City, Huanggang, Hubei, 438000, China)
出处
《心血管康复医学杂志》
CAS
2018年第3期289-293,共5页
Chinese Journal of Cardiovascular Rehabilitation Medicine
