西洛他唑与尼莫地平联合应用防治蛛网膜下腔出血迟发性脑血管痉挛的疗效

Effects of Cilostazol and Nimodipine Combined Therapy on Delayed Cerebral Vasospasm after Subarachnoid Hemorrhage

目的探讨联合用药对蛛网膜下腔出血(SAH)后迟发性脑血管痉挛防治的临床疗效。方法 210例SAH患者随机分成对照组(n=105):常规治疗加尼莫地平1 mg/h持续泵入14 d;治疗组(n=105):在对照组治疗基础上同时应用西洛他唑50mg,2次/d。连用14 d。2组均持续监测生命体征,比较治疗前后2组临床表现,意识变化以脑血管痉挛(GCS)、病情以Hunt&Hess分级,预后以CT、MRI、TCD结果为评价指标。结果 (1)总体病情、GCS、Hunt&Hess分级及Fisher分级:治疗前2组无明显差异(P>0.05)。(2)头部CT或MRI:治疗组出现脑梗死灶11例(10.5%),低于对照组(23例,21.9%)(P<0.05)。(3)TCD:出血后1 d大脑中动脉(MCA)平均流速对照组(115.6±12.5)cm/s,治疗组(112.5±10.92)cm/s,两组比较无统计学差异(P>0.05)。分别比较3,7,14 d血流速度,治疗组比对照组明显下降(P<0.05);(4)疗效:治疗组显效率(74.3%)明显高于对照组(60.0%)(P<0.05)。结论 SAH后迟发性脑血管痉挛的联合防治效果更佳。

Objective To discuss the clinical effects of cilostazol and nimodipine combined therapy on cerebroval vasospasm（CVS） after subarachnoid hemorrhage（SAH）.Methods Totally 210 patients with intracranial SAH were randomly divided into control group and treatment group.The patients in control group were treated with nimodipine 1 mg/h pumping continuously for 14 days.The patients in the treatment group were given nimodipine 1 mg/h pumping continuously and cilostazol 50 mg twice per day for 14 days.Vital signs were monitored continuously in all patients.The clinical data of pre-and post-therapy in the two groups,such as clinical manifestation,the level of consciousness（GCS grade,Hunt ＆ Hess scores）,CT,TCD and MRI,were compared.Results There was no significant difference in GCS grade,Hunt ＆ Hess,Fisher pre-therapy between the two groups（P 〉 0.05）.The incidence of cerebral infarction in the treatment group [11（10.5%）] was lower than that of the control group [23（21.9%）]（P 〈 0.05）.TCD showed the mean blood flow of median cerebral artery（MCA） was 115.6±12.5 cm/s in control group and 112.5±10.9 cm/s in the treatment group（1 day after hemorrhage）,and there was no difference between the two groups（P 〉 0.05）.The mean blood flow of MCA on 3,7 and 14 days after hemorrhage in the treatment group was obviously slower than those of the control group（P 〈 0.05）.The effective rate of the treatment group（74.3%） was higher than that of the control group（60.0%）（P 〈 0.05）.Conclusion The combined therapy of cilostazol and nimodipine was effective for delayed CVS after SAH.