尼莫地平治疗急性脑外伤临床效果分析

Clinical Effect of Nimodipine on Acute Head Injury

目的研究尼莫地平对急性脑外伤蛛网膜下腔出血脑血流速度的改变，以及颅内压增高对尼莫地平治疗作用的影响。方法选择我科自１９９６年１月－１９９７年４月收治的急性脑外伤伴外伤性蛛网膜下腔出血病人乃例，随机分成治疗组与对照组，通过经颅多普勒（ＴＣＤ）检测尼莫地平对脑血流速度的影响，同时经颅内压监测观察颅内压对尼莫地平作用的影响。结果对照组ＧＣＳ≥９分１８例中，１３例存在脑血流速度增快治疗组ＧＣＳ≥９分１３例中，仅４例存在脑血流速度增快，两组比较有非常显著性差异（Ｐ＜０．０１）；治疗组中１８例颅内压＞２００ｍｍＨ２Ｏ（１．９６ｋＰａ）中，１５例脑血流速度增快，而１１例颅内压＜２００ｍｍＨ２Ｏ中，仅４例脑血流速度增快，两者比较有显著性差异（Ｐ＜０．０５）。结论尼莫地平对急性外伤性蛛网膜下腔出血有明显的预防脑血流速度增快的作用，能够改善治疗效果。而颅高压可影响尼莫地平的治疗作用。

Objective To study the changes of cerebral blood flow (CBF) and the effeCtsof intracranial pressure (ICP) on nimodipine treating acute traumatic subarachnoid hemorrhage (t - SAH). Methods Seventy - five patients with traumatic subarachnoid hemorrhagehospitalized in our hOSPital from January 1996 to Apec 1997, were randomly divided into thetreatment group and the control group. Transcranial DoPPler (TCD) was ugh to deter CBFvelocity chance and ICP was observed. Results For the patients whose GCS > 9, in thecontrol group, among 18 cases, there were 13 caac whose CBF velocity increase; but in thetyffitmeflt group, amoflg 13 cases, only increase in 3 cases. In the treatmwt greup, among19 cases whose ICP>200 mmH2O, there were 15 cases whose CBF velocity increased; butamong 11 caac whose ICP < 200 mmH2O, only increase in 4 cases. Conclusion Nimodipinecan prevent CBF velocity from booming too fast in acute t-SAH and improve the treatingresults. And the increased ICP might affect the treatment of nimodipine.