参麦注射液联合尼莫地平治疗外伤性蛛网膜下腔出血伴脑血管痉挛的效果观察

Efficacy of Shenmai injection combined with nimodipine for traumatic subarachnoid hemorrhage with cerebral vasospasm

目的观察参麦注射液联合尼莫地平治疗外伤性蛛网膜下腔出血(t SAH)伴脑血管痉挛(CVS)的效果。方法选取t SAH伴CVS患者50例,其中25例患者在常规治疗的基础上单用尼莫地平治疗,为对照组;另25例患者在常规治疗的基础上联用参麦注射液和尼莫地平治疗,为研究组。观察并比较两组患者给药后1、3、5、7、14d的大脑中动脉平均血流速度(MFV)、格拉斯哥昏迷评分(GCS)、血清一氧化氮(NO)与内皮素-1(ET-1)水平,同时比较两组患者治疗前、治疗14d后蒙特利尔认知评估量表(MoCA)评分,以及疗效与不良反应发生情况。结果研究组患者给药后5、7、14d的大脑中动脉MFV均明显低于对照组(均P<0.05),给药后7、14d的GCS评分均明显高于对照组(均P<0.05),给药后7、14d的血清NO水平明显高于对照组(均P<0.05)。两组患者给药1、3、5、7、14d的ET-1水平比较无统计学差异(均P>0.05)。两组患者治疗前、治疗后MoCA评分比较差异均无统计学意义(均P>0.05)。治疗后,两组患者MoCA评分均高于治疗前(均P<0.05)。研究组患者治疗总有效率高于对照组(92.0%vs 68.0%,P<0.05)。两组患者治疗期间肝功能异常、再出血、低血压及恶心、呕吐等不良反应发生率比较差异均无统计学意义(均P>0.05)。结论参麦注射液联合尼莫地平治疗t SAH伴CVS疗效确切,安全,值得临床推广应用。

Objective To evaluate the clinical efficacy of Shenmai injection combined with nimodipine for traumatic subarachnoid hemorrhage (tSAH) with cerebral vasospasm (CVS). Methods Fifty tSAHpatients with CVS were recruited, among whom25 cases were treated with nimodipine on the basis of conventional therapy (control group) and 25 cases were treated with Shenmai injection combined with nimodipine in addition to conventional therapy (study group). The mean flow velocity (MFV) of the middle cerebral artery, Glasgowcoma score (GCS), serumnitric oxide (NO) and endothelin-1 (ET-1) weremeasured and compared between the two groups at 1, 3, 5, 7 and 14 days after administration. Meanwhile, cognitive function, efficacy and adverse reactions of Montreal Cognitive Assessment (MoCA) were compared between the two groups before and after 14 days of treatment. Results The MFV of the study group was significantly lower than that of control group at 5, 7 and 14 days after administration (all P<0.05), and the GCS score at 7 and 14 days after administration was significantly higher than control group (all P<0.05). There was no significant difference in MoCA cognitive function between the two groups before and after treatment (all P>0.05). After treatment, the cognitive function of MoCA in both groups was higher than that before treatment (all P<0.05). The total effective rate in the study group was higher than that in the control group (92.0%vs. 68.0%, P<0.05).There was no significant difference in the incidence of liver dysfunction, re-bleeding, hypotension, nausea, vomiting and other adverse reactions between the two groups (all P >0.05). Conclusion Shenmai injection combined with nimodipine is effective and safe for treatment of tSAH with CVS, and worthy of clinical application.