法舒地尔联合尼莫地平治疗脑动脉瘤栓塞术后脑血管痉挛疗效观察

Fasudil combined with nimodipine treatment in patients with cerebral vasospasm after intracranial aneurysm embolism surgery

目的探讨法舒地尔联合尼莫地平对脑动脉瘤栓塞术后脑血管痉挛患者Glasgow昏迷评分(GCS)、生活质量及脑梗死发生率的影响。方法选取西电集团医院2013年5月至2016年5月收治的脑动脉瘤栓塞术后脑血管痉挛患者100例,采用随机数字表法分为单一用药组(n=50)和联合用药组(n=50)。单一用药组给予尼莫地平单用;联合用药组给予尼莫地平联合法舒地尔治疗。比较两组患者治疗前、后GCS,Barthel指数评分,神经功能缺损(NFI)评分,大脑中动脉(MCA)平均血流速度,术后3个月Glasgow预后分级(GOS)情况及术后30 d脑梗死发生率等。结果联合用药组患者治疗后GCS评分、Barthel指数评分及NFI评分均明显优于治疗前、单一用药组,差异均有统计学意义(P<0.05);联合用药组患者治疗后MCA平均血流速度明显快于治疗前、单一用药组,差异均有统计学意义(P<0.05);联合用药组患者术后3个月GOS分级明显优于单一用药组,差异有统计学意义(P<0.05);联合用药组患者术后30 d脑梗死发生率明显低于单一用药组,差异有统计学意义(P<0.05)。结论法舒地尔联合尼莫地平治疗脑动脉瘤栓塞术后脑血管痉挛可有效改善患者意识状态,提高日常生活质量,降低远期脑梗死发生率。

Objective To explore the influence of fasudil combined with nimodipine on the Glasgow coma scale（ GCS） score,quality of life and cerebral infarction incidence of patients with cerebral vasospasm after intracranial aneurysm embolism surgery. Methods A retrospective study was performed on 100 patients with cerebral vasospasm after intracranial aneurysm embolism surgery in Xi＇an XD Group Hospital from May 2013 to May 2016. Patients were randomly divided into the control group（ n = 50,using single nimodipine）and the combination group（ n = 50,using nimodipine combined with fasudil）. The GCS scores,Barthel index scores,NFI scores and the mean value of MCA blood flow velocity before and after treatment,GOS classification in 3 months after operation and the cerebral infarction incidence in 30 days after operation of both groups were compared. Results The GCS scores,Barthel index scores and NFI scores of combination group after treatment were significant better than those of control group and before treatment（ P〈0. 05）; the mean value of MCA blood flow velocity of combination group after treatment were significant faster than that of control group and before treatment（ P〈0. 05）; the GOS classification in 3 months after operation of combination group were significant better than that of control group（ P〈0. 05）; the cerebral infarction incidence in 30 days after operation of combination group were significant lower than that of control group（ P〈0. 05）. Conclusion Fasudil combined with nimodipine in the treatment of patients with cerebral vasospasm after intracranial aneurysm embolism surgery can efficiently improve the consciousness state,improve the quality of daily life and be helpful to avoid the occurrence of long-term cerebral infarction.