早期尼卡地平用于蛛网膜下腔出血对患者脑血流的改善及CVS的预防作用

Early using nieardipine for improving cerebral blood flow and preventing CVS in patients with subarachnoid hemorrhage

目的研究早期尼卡地平对蛛网膜下腔出血患者脑血流的改善及脑血管痉挛（CVS）的预防作用。方法选取本院2015年1月10月收治的70例蛛网膜下腔出血患者为研究对象，将以上患者抽签随机分为观察组与对照组，每组35例。对照组常规镇静、镇痛、控制颅内压、预防再出血，治疗前检测患者颅内压、脑血流；观察组在对照组基础上采取尼卡地平治疗。于入院即刻，治疗后7、14、21d比较两组脑血流、颅内压的改变，并且观察CVS发生情况及预后。结果两组颅内压及脑血流入院即刻比较，差异无统计学意义（P〉0．05）；治疗后7、14、21d，观察组颅内压分别为（19．42±3．42）mmHg（1mmHg=0．133kPa）、（13．05±1．86）mmHg、（11．74±2．54）mmHg，显著低于对照组[（27．42±5．01）mmHg、（16．75±1．67）mmHg、（20．60±1．85）mmHg]（P〈0．05）；治疗后7、14、21d，观察组脑血流速度分别为（104．25±20．41）cm／s、（101．55±10．25）cm／s、（94．81±9．6）cm／s，显著低于对照组[（134．24±28．66）cm／s、（117．25±25．41）cm／s、（113．66±8．68）cm／s]（P〈0．05）。观察组CVS发生率及重残患者比例分别为2．86％、8．57％，显著低于对照组的17．14％、28．57％（P〈0．05）；两组良好、中残所占比例比较，差异无统计学意义（P〉O．05）。结论尼卡地平治疗蛛网膜下腔出血效果显著，对脑血流及颅内压的改善及CVS的预防作用显著，且可改善患者预后，有较高的临床应用价值。

Objective To study the effect of early using nicardipine for improving cerebral blood flow and preventing CVS in patients with subarachnoid hemorrhage. Methods 70 patients with subarachnoid hemorrhage treated at our hospital from January to October, 2015 were selected as study objects and were divided into an observation group and a control group by random lot method, 35 cases for each group. The control group received conventional sedation, analgesia, control of intracranial pressure, and prevention of rebleeding; the intracranial pressure and cerebral blood flow were detected before the treatment. In addition, the observation group were treated with nicardipine. The changes of cerebral blood flow and intracranial pressure in the two groups were compared when admitted and 7, 14, and 21 days after the treatment. The occurrence of CVS and prognosis were observed. Results There were no statistical differences in intracranial pressure and cerebral blood flow between these two groups when admitted （P 〉 0.05）. 7, 14, and 21 days after the treatment, the intracranial pressure was （19.42±3.42） mmHg （ 1 mmHg=0.133 kPa ） , （13.05±1.86） mmHg, and （11.74±2.54） mmHg and cerebral blood flow velocity （104.25±20.41） cm/s, （101.55±10.25）cm/s, and （94.81±9.6） cm/s in the observation group, respectively and was （27.42±5.01） mmHg, （16.75±1.67） mmHg, and （20.60±1.85） mmHg and （134.24±28.66） cm/s, （117.25±25.41） cm/s, and （113.66±8.68） cm/s in the control group, respectively （P 〈 0.05）. The incidence of CVS and the proportion of the patients with severe disability were 2.86% and 8.57% in the observation group and were 17.14% and 28.57% in the control group （P 〈 0.05）. There were no statistical differences in the good rate and moderate disability rate between these two groups （P 〉 0.05）. Conclusions Nicardipine has remarkable efficacy in the treatment of subarachnoid hemorrhage and can significantly improve the patients＇ cerebral blood flow, intracranial pressure, and prognosis and remarkably prevent CVS, so its clinical application value is high.