摘要
目的探讨尼莫地平术中灌洗对颅内动脉瘤开颅夹闭术患者术后脑血管痉挛的预防效果。方法选取中国人民武装警察部队特色医学中心2019年10月至2022年1月收治的60例颅内动脉瘤患者,按随机数字表法分为对照组和观察组,各30例。2组患者由同一组医师实施颅内动脉瘤开颅夹闭术,对照组术区以0.9%氯化钠注射液冲洗,至冲洗液清亮;观察组取注射用尼莫地平4 mg+0.9%氯化钠注射液500 ml,配置溶液对术区进行灌洗。比较2组出院时疗效,术后脑血管痉挛发生率,手术前后大脑中动脉、后动脉及椎基底动脉平均血流速度,手术前后相关实验室指标水平。结果观察组与对照组出院时预后良好率比较[96.7%(29/30)比90.0%(27/30)],差异无统计学意义(P=0.605)。观察组术后脑血管痉挛发生率明显低于对照组[3.3%(1/30)比23.3%(7/30)],差异有统计学意义(P=0.023)。2组术后1周大脑中动脉、后动脉及椎基底动脉平均血流速度均低于术前,且观察组均低于对照组,差异均有统计学意义(均P<0.05)。2组术后1周可溶性血管细胞黏附分子1(sVCAM-1)、神经元特异性烯醇化酶(NSE)水平均低于术前,中枢神经特异性蛋白(S100β)水平均高于术前,且观察组术后1周sVCAM-1、NSE水平低于对照组,S100β水平高于对照组,差异均有统计学意义(均P<0.05)。结论尼莫地平术中灌洗可减少颅内动脉瘤开颅夹闭术患者术后脑血管痉挛的发生,减少大脑动脉血流速度,减轻脑组织损伤程度,改善患者预后。
Objective To investigate the effect of intraoperative lavage with nimodipine on the prevention of postoperative cerebral vasospasm in patients undergoing intracranial aneurysm craniotomy clamping.Methods Sixty patients with intracranial aneurysm admitted to Characteristic Medical Center of Chinese People′s Armed Police Force from October 2019 to January 2022 were selected.They were divided into the control group and the observation group according to the random number table method,with 30 patients in each group.The control group was treated with intracranial aneurysm craniotomy clipping,and the operation area was flushed with 0.9%sodium chloride injection until the flushing solution was clear.The operation area of the observation group had lavage with 4 mg of nimodipine solution+500 ml of 0.9%sodium chloride injection.The prognosis at discharge,incidence of postoperative cerebral vasospasm,average blood flow velocities of middle cerebral artery,posterior cerebral artery,vertebral basilar artery,and levels of relevant laboratory factors before and after operation were compared between the two groups.Results There was no significant difference in the rate of good outcome at discharge between the observation group and the control group[96.7%(29/30)vs 90.0%(27/30)](P=0.605).The incidence of postoperative cerebral vasospasm in the observation group was significantly lower than that in the control group[3.3%(1/30)vs 23.3%(7/30)](P=0.023).The average blood flow velocities of middle cerebral artery,posterior cerebral artery and vertebral basilar artery in both groups 1 week after surgery were lower than those before surgery,and the velocities in the observation group were lower than those in the control group(all P<0.05).The levels of soluble vascular cell adhesion molecule-1(sVCAM-1)and neuron specific enolase(NSE)in both groups 1 week after surgery were lower than those before surgery,and the levels of central nervous specific protein(S100β)were higher than those before surgery;compared to the control group,the leve
作者
王素青
黄生炫
杨帆
Wang Suqing;Huang Shengxuan;Yang Fan(Institute of Nerve Trauma and Repair,Characteristic Medical Center of Chinese People's Armed Police Force,Tianjin 300162,China;Department of Neurosurgery,Affiliated Sanming First Hospital of Fujian Medical University,Sanming 365000,China;Department of Neurosurgery,Baoji High-tech Hospital,Baoji 721000,China)
出处
《中国医药》
2023年第3期376-380,共5页
China Medicine
基金
福建省卫生健康中青年骨干人才培养项目(2021GGB022)。
关键词
颅内动脉瘤
开颅夹闭术
脑血管痉挛
尼莫地平
Intracranial aneurysm
Craniotomy clipping
Cerebral vasospasm
Nimodipine
