超选择性动脉内灌注维拉帕米治疗蛛网膜下腔出血后脑血管痉挛的疗效分析

Effect of super selective intra-arterial infusion of verapamil for the treatment of cerebral vasospasm after subarachnoid hemorrhage:an efficacy analysis

目的探讨超选择性动脉内灌注维拉帕米治疗动脉瘤性蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)的疗效。方法回顾性分析2013年1月至2016年2月对颅内动脉瘤开颅夹闭(8例)或血管内治疗(7例)后出现CVS 15例SAH患者的临床资料,对15例患者均进行全脑DSA,使用微导管超选择至痉挛的动脉并灌注维拉帕米(11.1±3.4)mg,对照治疗前后全脑DSA表现,搜集治疗过程中血压、心率,记录灌注前后经颅多普勒超声结果,随访6个月并进行格拉斯哥预后评分(GOS)。结果 (1)对15例患者共实施了20支动脉内的灌注治疗,灌注前后比较,DSA上CVS改善14例,无明显变化1例。(2)经颅多普勒超声检查大脑中动脉的平均脑血流速度(mBFV),由超选择灌注术治疗前的(181±4)cm/s降至治疗后1 h内的(126±4)cm/s,差异有统计学意义(t=42.46,P<0.01),无一例发生使用微导管所导致的并发症。(3)灌注过程中监测患者右上臂血压,灌注开始时收缩压为(138±8)mmHg,灌注结束时为(135±10)mmHg,术后1 h为(137±7)mmHg;手术开始时心率为(83±6)次/min,手术结束时为(79±8)次/min,至术后1 h为(80±5)次/min,差异均无统计学意义(P>0.05)。(4)对所有患者随访6个月,6个月时的GOS评分:恢复良好9例,中度病残但能生活自理3例,重度病残生活不能自理3例。无一例植物生存或死亡。结论超选择性动脉内灌注维拉帕米,能有效改善动脉瘤性SAH造成的CVS,同时对心率及血压无明显影响。

Objective To investigate the efficacy of super selective intra-arterial infusion of verapamil for the treatment of cerebral vasospasm （CVS） after subarachnoid hemorrhage （SAH）.Methods From January 2013 to February 2016,the clinical data of 15 patients with subarachnoid hemorrhage （SAH） who had CVS after intracranial aneurysm clipping （n=8） or endovascular treatment （n=7） were analyzed retrospectively.All patients received whole brain digital subtraction angiography （DSA）.Microcatheter super selection to spastic arteries was used and verapamil （11.1±3.4 mg） was infused.The findings of whole brain DSA before and after treatments were compared.The blood pressure and heart rate were collected during the treatment and the findings of transcranial Doppler ultrasonography were recorded.The patients were followed up for 6 months and the Glasgow outcome scale （GCS） scores were obtained.Results （1） A total of 20 intra-arterial infusion treatments were performed in 15 cases.They were compared before and after perfusion.CVS was improved on DSA in 14 cases,there was no significant change in on cases.（2） Transcranial Doppler ultrasonography showed that the mean blood flow velocity （mBFV） of the middle cerebral artery was decreased from 181±4 cm/s before the super selective intra-arterial infusion to 126±4 cm/s within 1 hour after treatment.There was significant difference （t=42.46,P〈0.01）.No complications associated with the use of microcatheters were observed.（3） The right upper arm blood pressure of the patients was monitored in the process of perfusion.The systolic pressure was 138±8 mmHg at the beginning of the perfusion,it was 135±10 mmHg at the end of the perfusion,and it was 137±7 mmHg at 1 h after the perfusion.The heart rate was 83±6/min at the beginning of the operation,it was 79±8/min at the end of the operation,and it was 80±5/min at 1 h after the operation.There were no significant differences （P〉0.05）.（4） All patients were followed up for 6 months.The GOS score at 6 months：good recovery in 9 cases,moderate disability but could take care of themselves in 3 cases,severe disability and could not take care of themselves in 3 cases,no persistent vegetative state or death.Conclusion Super selective intra-arterial infusion of verapamil can effectively improve the treatment of aneurysmal SAH caused CVS.At the same time,it has no obvious effect on blood pressure and heart rate.