尼莫地平治疗重型颅脑损伤术后大面积脑梗死的临床研究

Clinical study of nimodipine on large area cerebral infarction of severe traumatic brain injury after operation

目的探讨重型颅脑损伤术后大面积脑梗死患者早期应用尼莫地平治疗的临床效果。方法将我院2009年1月至2012年1月人院的重型颅脑损伤术后大面积脑梗死患者51例作为治疗组，将2005年1月至2008年12月入院的同类患者48例作为对照组。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确诊后立即给予尼莫地平注射液静脉泵入，持续10d后改为尼莫地平片口服，疗程10d。于入院时和第5、11、21天检测血浆内皮素一l，应用经颅多普勒检测伤侧大脑中动脉收缩峰流速（Vp），连续监测颅内压7d，伤后3个月随访记录格拉斯哥预后评分（GOS），恢复良好及中、重度残为治疗有效，记录其意识恢复觉醒时间。结果治疗组治疗第2l天死亡22例，存活患者脑血管痉挛发生率为48．28％（14／29），对照组死亡30例，存活者血管病率发生率为83．33％（15／18），差异有统计学意义（x2=5．78，P〈0．05）；两组治疗后伤侧大脑中动脉的Vp值（F分组=276．27，F时间=603．54，F交互=85．68）、血浆内皮素-1（F分组=281．16，F时间=608．32，F交互=87．45）和颅内压（F分组：326．58，F洲：78．63，F交互=27．39）均呈下降趋势（P均〈0．05）。3个月后治疗组有效率为52．94％（27／51），对照组为31．25％（15／48），疗效差异有统计学意义（x2=4．76，P〈0．05）；治疗有效者觉醒时间分别为（20．7±6．5）、（27．8±7．6）d，两组比较差异有统计学意义（t=3．19，P〈0．05）。结论重型颅脑损伤术后大面积脑梗死患者早期应用尼莫地平治疗可明显提高临床疗效，缩短昏迷时间。

Objective To investigate the clinical effect of early application of nimodipine on a large area cerebral infarction after severe traumatic brain injury operation. Methods Fifty-one patients with severe head injury ＂after large area cerebral infarction were as treatment group who hospitalized from January 2009 to January 2012 ,and 48 hospitalized cases as the control group from January 2005 to January 2008. The patients in control group were received drugs to decrease intracranial pressure ,and enhance nerve nutrition therapy ,while in the treatment group, beside the therapy method of control group, were received nimodipine intravenously by micro-pump for l0 days,and then oral administration for l0 days. Plasma endothelin-1 was detected at 0,5th, 7th, 14th day days after hospitalization. Dopple was pplied to record the middle cerebral artery （MCA） peak systolic velocity（Vp） of the injured side for 7 d. Glasgow outcome score （GOS） was recorded in the 3 months follow-up. The awakening time was recorded consciousness. Results At 21st day after treatment,22 cases were died in the treatment group and survival patients with cerebral vasospasm were 14 cases （48.28% ,14/29）. However,30 cases were died in control group and cerebral vasospasm（CVS） of survival patients was 15 cases （83.33%, 15/18）, significantly higher than that in treatment group（ X2 = 5.78, P 〈 0.05）. The variable tendencies of Vp, plasma endothelin-1 and the intracranial pressure were significantly different between the treatment group and the control group （ Vp ： F group = 276.27, Ftime = 603.54, F interactive = 85.68 ; plasma endothelin -1 ：F grouP = 281.16, F time = 608.32, F interactive = 87.45; intracranial pressure： F grouP = 326. 58, F time = 78.63, F interactive = 27. 39 ; P 〈 0. 05 ）. After 3 months of treatment, the value of GOS was significantly higher in treatment group than that of control group （ X2 = 4. 76, P 〈 0. 05 ）. Furthermore through three months treatment, the effective rate in treatment group was higher than that in the control group （52. 94% （ 27/51 ） vs. （ 31.25 % （ 15/48 ） ）, the awakening periods was shorter than that in control group （ （ 20. 7± 6. 5 ） d vs. （27. 8± 7. 6） d, t = 3. 19, P 〈 O. 05 ） ）. Conehtsion Early applications of nimodipine treatment after severe traumatic brain injury patients with massive cerebral infarction can significantly improve the clinical efficacy and shorten the duration of coma.