尼莫地平与硫酸镁治疗蛛网膜下腔出血后脑血管痉挛随机对照研究

Randomly controlled study on the treatment effect of Nimodipine and magnesium sulfate on cerebral vasospasm after subarachnoid hemorrhage

目的探讨尼莫地平与硫酸镁治疗蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)效果,为治疗蛛网膜下腔出血后脑血管痉挛提供临床依据。方法采用回顾性调查方法,选取我院2011-01—2012-12收治的蛛网膜下腔出血后脑血管痉挛患者68例,随机分为对照组和治疗组各34例,对照组给予尼莫地平治疗,治疗组以尼莫地平联合硫酸镁治疗。结果治疗组显效率58.82%(20/34),高于对照组47.06%(16/34),差异有统计学意义(P<0.05);治疗组无效率20.59%(7/34),低于对照组的29.41%(10/34),差异有统计学意义(P<0.05);2组治疗后MCA血流速度均明显降低,均低于治疗前(P<0.05);治疗组治疗后为(86.5±17.1)cm/s,低于对照组的(98.4±16.9)cm/s(P<0.05)。2组治疗后GCS评分均高于治疗前,差异有统计学意义(P<0.05);治疗组治疗后GCS预后评分为12.31±4.15,高于对照组10.72±3.76(P<0.05)。治疗组脑血管痉挛和再出血分别为8.82%(3/34)和2.94%(1/34),低于对照组14.70%(5/34)和8.82%(3/34)(P<0.05);治疗组低血压为5.88%(2/34),低于对照组14.70%(5/34)(P<0.05)。结论尼莫地平联合硫酸镁治疗蛛网膜下腔出血后脑血管痉挛效果较好。

Objective To investigate the treatment effect of Nimodipine and magnesium sulfate on cerebral vasospasm （CVS） after subarachnoid hemorrhage, and provide the clinical basis for the treatment of CVS secondary to SAH. Methods By retrospective study, 68 SAH patients with CVS were treated in our hospital from January 2011 to December 2012, and divided into the control group and the treat group, 34 cases in each group. The control group was treated with nimodipine, and the treatment group was given nimodipine combined with magnesium sulfate. Results The efficiency of the treatment group was 58.82% （20/34）, higher than that of the control group 47.06% （16/34） （P〈0.05）; The ineffective rate of the treatment group was 20.59% （7/34）, lower than that of the control group 29.41% （10/34） （P〈0.05）; after treatment, MCA blood flow velocity of the two groups were reduced obviously, were obviously lower than those before theatment （P〈0.05）; MCA blood flow velocity of the treatment group after treatment was 86.5 ± 17.1 cm/s, lower than that of the control group 98.4±16.9 cm/s （P〈0.05）. After the treatment, GCS scores were higher than those of pre--treatment, the difference was statisti- cally significant （P〈0.05）; After treatment, GCS score of the prognosis of the treatment group was 12.31 ± 4.15, higher than that of the control group 10.72 ± 3.76 （P〈0.05）. In the treatment group, the incidence rate of cerebral vasospasm and rebleeding was 8.82% （3/34） and 2.94% （1/34）, which were lower than those of the control group 14.70% （5/34） and 8.82% （3/34） （P〈0.05） ; The incidence of hypotension in the treatment group was 5.88% （2/34）, lower than that of the control group 14.70% （5/34） （P〈0.05）. Conclusion The treatment effective of Nimodipine combined with magnesium sul- fate in cerebral vasospasm after subarachnoid hemorrhage was better than that of Nimodipine.