尼莫地平对脑出血患者血肿周围“半暗带”的影响

The Effect of Nimodipine on the Penumbra Surrounding the Hematoma of the Patients with Intracerebral Hemorrhage

目的动态观察尼莫地平对脑出血患者血肿周边"半暗带"区灌注及代谢的影响。方法30例符合入选标准的高血压脑出血患者随机分为治疗组及对照组,治疗组在常规治疗基础上加用尼莫地平治疗,于发病1、3、5、25d采用动态磁共振(MRI)评定,获取所需的弥散加权成像、灌注加权成像和磁共振波谱等观察数据。结果5d时治疗组"半暗带"出现的阳性百分率明显低于对照组;在相应的时间点,治疗组与对照组"半暗带"区异常ADC体积、rrADC值、rrCBV值、rrCBF值、rrNAA值、rrLac值等各项指标均有显著差异;25d时2组阳性病例的血肿量差值及血肿吸收率及5d时的NIHSS评分有显著差异。结论尼莫地平能改善血肿周边"半暗带"区的脑血容量、脑血流量及细胞代谢,挽救血肿周边的可逆性缺血缺氧状态,加快血肿吸收。

Objective To observe dynamically the effect of nimodipine on the perfusion and metabolism of the penumbra surrounding the hematoma of the patients with intracerebral hemorrhage.Methods 30 patients which were according with the selective standards were divided into the nimodipine treatment group and the control group randomly.All patients were given routine treatment and nimodipine treatment group were given additional nimodipine treatment.In the dynamic state,MRI were performed on the 1th,3th,5th,25th day after the onset of symptoms of the patients.The data about DWI,PWI,1H-MRS were collected and analyzed.Results The masculine percentage of the penumbra surrounding the hematoma in the treatment group was significantly lower than that in the control group.The volumes of abnormal ADC,the value of rrADC,rrCBV,rrCBF,rrNAA and rrLac were significantly different between the nimodipine treatment group and control group at corresponding point-in-time.The absorption ratio of the hematoma on the 25th day and the NIHSS on the 5th were significantly different between the masculine patients of two groups.Conclusion Nimodipine can improve the cerebral blood volume,the cerebral blood flow and the cellular metabolism of the patients with intracerebral hemorrhage,and retrieve the penumbra surrounding the hematoma,and facilitate the resolution of the hematoma.