尼莫地平对创伤性蛛网膜下腔出血的临床疗效

Clinical effect of nimodipine on traumatic subarachnoid hemorrhage

目的探讨尼莫地平对创伤性蛛网膜下腔出血(tSAH)的临床疗效。方法将62例tSAH患者按入院顺序分为治疗组及对照组,每组31例;对照组给予保守治疗,治疗组在对照组治疗基础上加用尼莫地平。分别于治疗前、治疗后3、5、7、10、14、21d进行GCS评分,颅骨钻孔放置脑实质型颅内压探头连续监测颅内压14天,分别于治疗前及治疗后3、5、7、14、21天行经颅多普勒超声检查检测伤侧大脑中动脉(MCV)的收缩峰血流速度(Vp),伤后3月进行GOS评分。结果治疗7 d后,治疗组GCS评分显著高于对照组(P<0.05),而颅内压显著低于对照组(P<0.05)。治疗后3 d,治疗组MCV Vp明显低于对照组(P<0.05)。治疗组脑血管痉挛(MCA Vp>120 cm/s)发生率(11/31,35.5%)明显低于对照组(18/31,51.6%,P<0.05),治疗组预后良好率(83.9%,26/31;GOS 4~5分)明显高于对照组(58.1%,18/31;GOS 1~3分,P<0.05)。结论在tSAH患者伤后早期应用尼莫地平可以减少CVS的发生,改善tSAH患者预后。

Objective To explore the clinical effect of nimodipine on traumatic subarachnoid hemorrhage （tSAH）. Methods Sixty-two patients with tSAH were prospectively recruited in this study and divided into treatment group （n=31） and.control group （n=31） according to their admission time. All the patients received conservative treatment. The patients in theitreatment group received nimodiping and the patients in the control group did not. The other treatment measure except nimodipine w^as similar between the two groups. GCS score was assessed before the treatment, and 3, 5, 7, 10, 14 and 21 days after the treatment. The intracrania[ pressure （ICP） was measured before the treatment, and 3, 5, 7, 10 and 14 days after the treatment. The velocity of middle cerebral artery （MCA） was detected by transcranial Doppler Sonography before the treatment, and 3, 5, 7, 10, 14 and 21 days after the treatment. The prognosis was assessed according to GOS 3 months after the injury. Results The mean velocities of MCA were significantly lower in the treatment group than in the control group 3 days after treatmnet. The rate of cerebral vasospasm （CVS; the velocity of MCA〉120 cm/s） was significantly lower in the treatment group （35.5%, 11/31） than that （58.1%, 18/31） in the control group （P〈0.05）. The mean GCS scores were ／ significantly higher in the treatment group than those in the control group 7 days after the treatment （P〈0.05）. The ICP values were significantly lower in the treatment group than those in the control group 7 days after the treatment （P〈0.05）. The rate of good prognosis （GOS 4 or 5 score） was significantly higher in the treatment group （83.9%, 26/31） than that （58.1%, 18/31） in the control group （P〈0.05）. Conclusions Nimodipine can decrease the rate of CVS at the early stage of tSAH and can improve the prognosis of patients with tSAH.