尼莫地平不同给药途径治疗外伤性蛛网膜下腔出血的疗效评价

Therapeutic effect of different administration routes of nimodipine on cranio-cerebral trauma with subarachoid hemorrhage

目的 评价外伤性蛛网膜下腔出血（t-SAH）或鼻饲早期通过不同给药途径应用尼莫地平治疗的效果.方法 将80例t-SAH患者随机分为4组,即对照组、口服或鼻饲给药组、静脉给药组、术野灌洗＋静脉给药组,每组20例.动态观察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 术野灌洗＋静脉给药组脑血管痉挛发生率和3个月后预后不良率[分别为25.0％ （5/20）比70.0％ （14/20）、55.0％ （11/20）、35.0％ （7/20）和30.0％ （6/20）比50.0％（10/20）、40.0％ （8/20）、35.0％ （7/20）]明显低于对照组、口服或鼻饲给药组、静脉给药组,差异均有统计学意义（均P＜0.05）.术野灌洗＋静脉给药组、静脉给药、口服或鼻饲给药组、对照组患者手术后1周、2周、3周Vp均较手术前低（均P＜0.05）；4组患者术后1周内颅内压变化均随水肿高峰期的变化呈现先升高后下降的趋势；术后4组患者GCS变化均呈上升趋势,手术后第21天,4组患者GCS评分均较手术后第1天明显升高,差异有统计学意义（均P＜0.05）.术野灌洗＋静脉给药组预后不良患者比例明显低于对照组和口服或鼻饲给药组[30.0％（6/20）比50.0％ （10/20）、40.0％ （8/20）,P＜0.05].结论 在颅脑创伤早期采用静脉给药联合术野灌洗的方式使用尼莫地平治疗t-SAH可以减少脑血管痉挛的发生.

Objeetlve To observe the therapeutic effect of different administration routes of nimodipine in treatment of cranio-cerebral trauma with subarachoid hemorrhage. Methods All 80 patients with cerebral injury complicated by subarachoid hemorrhage [ glasgow coma scale （GCS） 6-12 ] were randomly divided into control group ,oral administration group （for 14 days）, intravenous injection group（ by micro-pump for 14 days ） and per- fused group（ perfused in operation and then injected） . Intracranial pressure, GCS and contraction peak flow velocity of middle cerebral artery were closely observed, and glasgow outcome scale （ GOS ） , complication were measured 3 months later. Results The proportion of cerebral vasospasm [ 25.0 （ 5/20 ） vs 70.0% （ 14/20 ） ,55.0% （ 11/20 ）, 35.0% （7/20） 1 and the rate of unfavourable prognosis [ 30. 0% （ 6/20 ） vs 50. 0% （ 10/20 ）, 40. 0% （ 8/20 ）, 35.0% （7/20） ] in perfused group were significantly lower than those in the other three groups（ all P 〈 0. 05）. The contraction peak flow velocity of middle cerebral artery at 1 week, 2 week ,3 week after operation in perfused group were less than those in the other three groups（ all P 〈 0.05 ）. The intracranial pressure in one week after operation in four groups showed the trends of rising first, and then decreasing. At 21th day after operation, compared to the first day postoperation ,the GCS score in four groups increased（ all P 〈0.05 ）. The ratio of patients of unfavourable prog- nosis in perfused group significantly less than those in control group and oral administration group [ 30.0% （6/20） vs 50.0% （10/20） ,40. 0% （ 8/20 ）, P 〈 0. 05 ]. Conclusion Nimodipine perfusing in operation can decrease the proportion of cerebral vasospasm and has a therapeuric effect on subarachoid hemorrhage in the early stage of cranio- cerebral trauma.