外伤性蛛网膜下腔出血患者早期应用尼莫地平防治脑血管痉挛的临床观察

Clinical Observation of Vasospasm in Patients with Traumatic Subarachoid Hemorrhage in the Early Stage

目的:观察外伤性蛛网膜下腔出血患者早期应用尼莫地平防治脑血管痉挛的临床效果。方法:将52例合并外伤性蛛网膜下腔出血的颅脑损伤患者随机均分为对照组和尼莫地平组。对照组患者行颅内压监测(ICP),采用脱水降颅内压、营养神经等治疗;尼莫地平组在对照组基础上于入院后立即给予尼莫地平注射液微泵维持匀速静脉注射,疗程14d,后改为尼莫地平片口服,疗程7d;对开颅手术的患者,术中以稀释后的尼莫地平注射液灌洗术野。监测2组入院后7d颅内压变化,记录21d格拉斯哥昏迷评分(GCS)、经颅多普勒(TCD)检测治疗前后大脑中动脉收缩峰流速、3个月后随访格拉斯哥预后评分(GOS),行统计学分析。结果:3周后TCD显示尼莫地平组伤侧大脑中动脉(MCA)收缩峰流速(Vp)低于对照组,脑血管痉挛发生率低,GCS评分从治疗后第5天起高于对照组,颅内压自第5天起低于对照组,据6个月后随访GOS,治疗组致残率低于对照组,4组数据经分析差异有统计学意义(P<0.05)。结论:早期应用尼莫地平,可以防止外伤性蛛网膜下腔出血后脑血管痉挛的发生或发展,减少脑梗死的发生并改善患者预后。

OBJECTIVE： To observe the clinical efficacy of nimodipine in the treatment of cerebral vasospasm in patients with traumatic subarachoid hemorrhage （SAH） in the stage. METHODS： 52 patients with cranio-cerebral trauma complicating with SAH were randomly divided into control group and nimodipine group. Control group received ICP and the treatment of dewatering and decreasing intracranial pressure and neurotrophy. Nimodipine group was additionally given intravenous injection of Nimodipine injection by micro-pump as soon as admission for 14 days, and then received Nimodipine oral tablets for 7 days on the basis of control group. Patients underwent craniotomy were given diluted Nimodipine injection for lavage. Changes of intracranial pressure of 2 groups were monitored for 7 days after admission, GCS score for 21 days and Vp of MCA before and after TCD were closely observed and GOS score of follow-up after 3 months were analyzed statistically. RESULTS： TCD indicated that Vp of MCA in nimodipine group was lower than control group after 3 weeks, the incidence of cerebral vasospasm was in low level. GCS score of nimodipine group was higher than control group since fifth day while intracranial pressure was lower than control group. The GOS of nimodipine group after 6 months was significantly higher than control group, there was statistical significance （P0.05）. CONCLUSION： Early treatment of nimodipine can prevent and treat the occurrence and aggravation of cerebral vasospasm in SAH patients, decrease the occurrence of cerebral infraction and improve prognosis of patients.