尼莫地平不同给药途径治疗重型颅脑外伤合并创伤性蛛网膜下腔出血

Role of different administration route of nimodipine on gravis type craniocerebral trauma complicating subarachnoid hemorrhage

目的:评价尼莫地平不同给药途径对重型颅脑外伤合并创伤性蛛网膜下腔出血患者脑血流的影响以及治疗效果。方法:68例重型颅脑外伤合并创伤性蛛网膜下腔出血患者随机分为(A)对照组,(B)尼莫地平静脉给药组,(C)尼莫地平术野灌洗组,术中采用TCD探测病变侧颈内动脉血流速度变化,分析尼莫地平对患者脑血流的影响;术后CT评价脑梗死情况,半年后进行GOS评分。结果:(1)C组脑血流速度在尼莫地平灌洗后明显下降(P<0.05),A、B组则无明显变化;(2)术后A、B、C3组患者脑梗死发生率分别20%,13.6%,7.69%,3组比较差异无显著性(P>0.05);(3)3组患者GOS评分比较:B、C2组比A组预后更佳(P<0.05)。结论:尼莫地平术中灌洗安全、有效,可以显著缓解颅内血管痉挛,结合术后静脉输注,能够降低术后脑梗死发生率。

OBJECTIVE To evaluate therapeutic efficacy of nimodipine at different administration route on gravis type craniocerebral trauma complicating subaraehnoid hemorrhage. METHODS A totai of 68 patients was divided into 3 groups. Group A： control group; group B： administrate nimodipine by iv; group C： nimodipine perfusing in operation. The cerebral blood flow velocities（BFV） of homolateral cervical internal carotid artery（CICA） were monitored by transcranial dopplar （TCD）. Effect of nimodipine on cerebral vasospasm （CVS） was analyzed. The information of cerbral infarction and CK）S score were collected after operation. RESULTS （1）BFV of CICA in group C significantly decreased after perfusion with nimotopin operation （P〈0. 05）, however,BFV of CICA in group A and B didn＇t significantly decrease （P〉0. 05）. （2） The incidence rate of cerbral infarction in 3 groups was 20%, 13.6%, 7. 69%, there were no statistic difference in the groups. （3） the progno- sis of group B and C was better than group A from GOS score（P〈0. 05）. CONCLUSION Pefusion with nimodipine can significantly alleviate CVS and decrease incidence rate of cerbral infarction.