依达拉奉联合高压氧治疗颅内动脉瘤术后脑血管痉挛的临床疗效

Clinical Effect of Edaravone Combined with HBO on Cerebral Vasospasm after Intracranial Aneurysm Surgery

目的观察依达拉奉联合高压氧(HBO)治疗颅内动脉瘤术后脑血管痉挛的临床疗效和安全性。方法选取2010年6月至2013年10月我院收治的52例颅内动脉瘤蛛网膜下腔出血的术后患者,随机分为观察组和对照组,每组26例。对照组采用依达拉奉常规治疗,观察组在对照组治疗的基础上联合HBO治疗。治疗前和治疗后4周,经颅多谱勒超声(Transcraninal Doppler,TCD)测量大脑中动脉平均血流速度评价血管痉挛程度,采用NIHSS评价神经功能缺损程度,MBI评价日常生活活动能力,并观察和比较两组患者不良反应的发生情况。结果治疗4周后,观察组大脑中动脉平均血流速度较对照组显著降低(P<0.05),脑血管痉挛的发生率显著低于对照组(P<0.05),MBI评分显著高于对照组,NIHSS评分较对照组明显降低(P<0.05)。两组患者的脑梗死发生率、死亡率以及不良反应的发生率比较均无显著差异(P>0.05)。结论依达拉奉联合HBO可以更有效地缓解颅内动脉瘤术后患者的脑血管痉挛,改善神经功能缺损程度,提高日常生活活动能力。

Objective To observe the clinical effect and safety of edaravone combined with high pressure oxygen（HBO） on cerebral vasospasm（CVS） after intracranial aneurysm surgery. Methods A total of 52 patients who were diagnosed as aneurysmal subarachnoid hemorrhage（a SAH） and underwent surgery between June 2010 and October 2011 in our hospital were selected and randomly divided into the observation group（26 cases） and control group（26 cases）. The control group was treated with conventional therapy and edaravone, while the observation group was added with HBO on the base of control group. The blood velocity of middle cerebral artery（MCA）, incidence rate of CVS, cerebral infarction and death rate were observed and compared between the two groups. Besides, NIHSS was used to evaluate the degree of nervous functional defects and MBI was used to evaluate the activities of daily living. Finally, the incidences of side effects were compared between the two groups. Results After 4 weeks＇ treatment, the blood velocity of MCA and incidence rate of CVS in the observation group were significantly lower than those in the control group（P〈0.05）. The NIHSS score of observation group was obviously lower than that of the control group. The MBI score of the observation group was significantly higher than that of the control group（P〈0.05）. Moreover, there was no significant difference in the incidence rates of cerebral infarction, side effects and yet death rate between the two groups（P〉0.05）. Conclusion Edaravone combined with HBO could more effectively alleviate the cerebral vasospasm, improve neurologic impairment and enhance the activities of daily living of patients after intracranial aneurysm surgery.