尼莫地平对急慢性脑血管痉挛的不同作用

The experimental study on the treatment and prevention effects of Nimodipine on acute and chronic cerebral vasospasm

目的：通过观察尼莫地平对蛛网膜下腔出血后急性和慢性脑血管痉挛的不同作用，为临床合理使用尼莫地平提供依据。方法：在家犬上复制蛛网膜下腔出血模型，分别观察在急性期和慢性期尼莫地平的解痉作用。并观察连续给尼莫地平对慢性脑血管痉挛有无预防作用。结果：在急性痉挛时，静脉注射尼莫地平０．１ｍｇ／ｋｇ后３０分钟，基底动脉口径由５９％±１３．６％扩大到９６．２％±１２．１％（Ｐ＜０．０１）；然而在慢性期，同样注射尼莫地平后，动脉口径扩张不明显（Ｐ＞０．０５）。在出血早期常规连续给尼莫地平（４０ｍｇ，口服，６小时１次，连续７天）无明显预防效果。结论：尼莫地平对急性期痉挛有明显扩张效果，而对慢性期痉挛无效。且常规剂量尼莫地平对慢性脑血管痉挛无明显预防作用。

Objective: To observe the effects with Nimodipine on acute and chronic cerebral vasospasm(CVS) for clinical effective application of Nimodipine. Methods: With a “double hemorrhage”canine model established by two blood injections of cisternal magna, the treatment on acute and chronic CVS and the prevention on chronic CVS with Nimodipine were observed separately. Results: (1) For the treatment of CVS, at 30th minute after Nimodipine (0 1mg/kg) given intravenously, the diameter of basilar artery changed from 59%±13 6% to 96 2%±12 1(P<0 01) of the basiline for acute CVS and from 60 6%±13 6% to 72 4%±19 6(P>0 05) for chronic CVS.(2) For the prevention of chronic CVS, the basilar arterial diameter on 7th day following SAH was 67 6%±11% in the nimodipine group and 52 7%±19 0% in the control group(P>0 05). Conclusion: Nimodipine has significant dilating effects on acute CVS, but no effective treatment and prevention on chronic CVS.