尼莫同治疗重型颅脑损伤合并蛛网膜下腔出血临床疗效评价

The therapeutic effect of nimodipine in treatment of severe traumatic brain injuries with subarachoid hemorrhage

目的评价尼莫同治疗重型颅脑损伤合并外伤性蛛网膜下腔出血的临床疗效。方法将60例合并外伤性蛛网膜下腔出血的重型颅脑损伤患者随机分为尼莫同组和对照组,尼莫同组予以尼莫同40mg24h微泵维持匀速静脉注射,疗程10d,后改为尼莫同片60mg,每天4次,疗程15d。对照组除未给予尼莫同外其他治疗相同。记录两组入院后10dGCS评分及监测7d的颅内压变化,行统计学分析;治疗后6个月时对两组GOS评分及脑积水、脑梗死等并发症的发生率进行比较,行统计学分析。结果尼莫同组GCS评分从治疗第4天始明显高于对照组(P<0.05);尼莫同组颅内压在前3d略高于对照组,但不存在统计学差异(P>0.05),自治疗后第4天始则明显低于对照组(P<0.05);尼莫同组脑梗死、脑积水发生例数明显少于对照组,迟发性出血例数略多于对照组,但两组无统计学差异(P>0.05);治疗后6个月GOS评分尼莫同组明显优于对照组,两组存在统计学差异(P<0.01)。结论尼莫同对重型颅脑损伤合并外伤性蛛网膜下腔出血有明显的治疗作用。

Objective To observe the therapeutic effect of nimodipine in treatment of severe cranio-cerebral trauma with subaraehoid hemorrhage （SAH）. Methods Sixty patients with severe cranio-cerebral injury complicated by SAH （GCS 3-8） were divided randomly into two groups. In nimodipine group 40 mg nimodipine was injected intravenously by micro-pump for ten days, then 60mg by oral administration QID ×15 days. In control group patients receives the same treatment measures but no nimodipine was given. Intracranial pressure and GCS were closely observed, GOS and complication were measured 6 months later. Results The GCS of nimodipine group from the first 4 days after treatment was significantly higher than that of the control group （P〈0.05）; the intracranial pressure of the nimodipine group was slightly higher than the control group in the first 3 days, but there was no significant difference （P〉0.05）. the incidences of cerebral infarction and hydrocephalus in the nimodipine group were significantly less than that of control group （P〈0.05）, the incidence of delayed bleeding slightly more than the control group, but there was no significant difference （P〉0.05）. The GOS of the nimodipine group after six months was significantly higher than the control group （P〈0.01）. Conclusion Nimodipine has definitive therapeuric effect for severe cranio-cerebral trauma with SAH.