尼莫地平治疗创伤性蛛网膜下腔出血的临床研究

Clinical Study of Therapeutic Effect of Nimodipine on Traumatic Subarachnoid Hemorrhage

目的:评价创伤性蛛网膜下腔出血早期应用防治脑血管痉挛药物尼莫地平治疗的临床效果。方法:将92例创伤性蛛网膜下腔出血患者随机分为对照组和治疗组,每组46例。对照组采用脱水降颅内压、营养神经等治疗;治疗组在对照组基础上于入院后立即给予尼莫地平注射液静脉泵入,疗程14d后改为尼莫地平片口服,疗程7d;开颅手术患者于术中以尼莫地平稀释液灌洗手术野。记录伤后格拉斯哥昏迷评分(GCS)变化,监测颅内压,应用经颅多普勒(TCD)检测伤侧大脑中动脉(MCA)收缩峰流速(Vp)变化,伤后3个月随访记录格拉斯哥预后评分(GOS)。结果:治疗组脑血管痉挛(CVS)发生率(15.22%)低于对照组(43.48%),差异有统计学意义(χ2=8.859,P<0.05),2组不同时间的Vp值、GCS和颅内压差异有统计学意义(P<0.05),3个月后治疗组预后不良率(30.43%)低于对照组(54.35%),差异有统计学意义(χ2=5.386,P<0.05)。结论:在颅脑创伤早期使用尼莫地平治疗创伤性蛛网膜下腔出血可以减少CVS的发生。

Objective： To observe the early therapeutic effect of nimodipine on cranio-cerebral trauma with subarachnoid hemorrhage （SAH）. Methods： Ninety-two patients with cerebral injury complicated by SAH were randomly divided into two groups （n=46 for each group）. Patients in treatment group were injected nimodipine intravenously by micro-pump for 14 days, and then oral administration for 7 days. Patients in control group were received the same treatment measures but without nimodipine. The values of intracranial pressure and Glasgow coma score （GCS） were observed. The systolic peak velocity （Vp） of middle cerebral artery （MCA） was detected by transcranial Doppler sonography （TCD） 3 months after injury. Results：The proportion （15.22%）of cerebral vasospasm（CVS）was significantly lower in treatment group than that of control group（43.48%, P 0.05）. The variable tendencies of Vp,GCS and the intracranial pressure were significantly different between the treatment group and the control group（P 0.05）. After 3 months of treatment, the value of GOS was significantly higher in treatment group than that of control group（P 0.05）. Conclusion：Nimodipine decreases the proportion of CVS and has definitive therapeutic effect for subarachnoid hemorrhage in the early stage of cranio-cerebral trauma.