尼莫地平在颅内动脉瘤手术治疗中的应用效果

Application of Nimodipine in the Surgical Treatment of Intracranial Aneurysms

目的:探讨尼莫地平应用于颅内动脉瘤(ICA)开颅夹闭术治疗中的临床价值。方法:选取2016年1月-2018年12月本院收治的ICA患者110例,均接受手术治疗,随机分为对照组(常规基础治疗上联合手术治疗)与观察组(对照组治疗的基础上加用尼莫地平创面浸洗),每组55例。比较两组患者临床疗效、脑血管痉挛(CVS)发生率、Glasgow昏迷评分(GCS评分);大脑中动脉(MCA)M1段、近心端(颈内动脉颅内段)及远心端(大脑前动脉A1段)血流速;脑脊液S100蛋白(CSF S100蛋白)、脂肪酸结合蛋白(FABP)、神经元特异性烯醇化酶(NSE)水平及不良反应发生情况。结果:观察组患者治疗总有效率为94.55%,高于对照组的80.00%,差异有统计学意义(P<0.05)。观察组患者CVS发生率为9.09%,显著低于对照组的41.82%,差异有统计学意义(P<0.05)。术后随访3个月,观察组患者GCS评分明显高于对照组,差异有统计学意义(P<0.05)。术后,两组MCA M1段、近心端、远心端动脉血流速均小于术前,且观察组在近心端、远心端动脉血流速均小于对照组,差异均有统计学意义(P<0.05)。术后7 d,两组CSF S100蛋白、FABP、NSE水平均高于术前,但观察组上述指标水平均低于对照组,差异均有统计学意义(P<0.05)。两组患者均未见明显不良反应。结论:尼莫地平应用于ICA手术治疗中可提高临床疗效,降低CVS的发生,改善患者昏迷程度、神经功能及颅内动脉血流速,且较为安全。

Objective:To investigate the clinical value of Nimodipine in the treatment of intracranial aneurysm (ICA) craniotomy.Method:A total of 110 cases of ICA patients admitted to our hospital from January 2016 to December 2018 were selected.All patients received surgical treatment,they were randomly divided into the control group (combined surgical treatment with conventional basic treatment) and the observation group (infusion of Nimodipine on the wound surface with the treatment of the control group),55 cases in each group.Clinical efficacy,incidence of cerebral vasospasm (CVS) and Glasgow coma score (GCS score) were compared between the two groups.Middle cerebral artery (MCA) M1 segment,proximal (internal carotid intracranial segment) and distal (anterior cerebral artery A1 segment) blood flow rate.Cerebrospinal fluid S100 protein (CSF S100 protein),fatty acid binding protein (FABP),neuron-specific enolase (NSE) levels and adverse reactions.Result:The total effective rate of the observation group was 94.55% higher than 80.00% in the control group,the difference was statistically significant (P<0.05).The incidence of CVS in the observation group was 9.09% significantly lower than 41.82% of the control group,the difference was statistically significant (P<0.05).Postoperative follow-up was conducted for3 months,the GCS score of the observation group was significantly higher than that of the control group,the difference was statistically significant (P<0.05).After surgery,the blood velocity of MCA M1 segment,proximal artery and distal artery in both groups were lower than those before surgery,the blood flow velocity of the proximal and distal arteries in the observation group were lower than those in the control group,the differences were statistically significant (P>0.05).7 days after surgery,the levels of CSF S100 protein,FABP and NSE in both groups were higher than those before surgery.However,the levels of the above indicators in the observation group were lower than those in the control group,the differences were statistically significant (P<0.05).No significant adverse reactions were observed in either group.Conclusion:The application of Nimodipine in ICA surgery can improve the clinical efficacy,reduce the occurrence of CVS,improve the coma degree,nerve function and intracranial arterial blood flow rate of patients,and is relatively safe.