长春西汀不同给药途径治疗破裂颅内动脉瘤栓塞术并发脑血管痉挛的疗效及安全性对比研究

Comparative study on efficacy and safety of different routes for vinpocetine injection by intravenous or trans-angiographic catheter on cerebral vasospasm following embolization of ruptured aneurysm

目的探讨经静脉滴注与经导引导管注入长春西汀治疗破裂颅内动脉瘤栓塞术并发脑血管痉挛(cerebral vascular spasm,CVS)的效果及安全性。方法选取行颅内动脉瘤栓塞术中发生CVS的动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,a SAH)患者共105例为研究对象,随机分为A组、B组和C组,每组35例。C组给予3H治疗,B组在C组基础上联合静脉泵注长春西汀,A组在C组基础上联合经导引导管注入长春西汀。比较各组大脑中动脉(middle cerebral artery,MCA)血流速度、美国国立卫生院卒中量表(National Institutes of Health stroke scale,NIHSS)评分、格拉斯哥预后(Glasgow outcome scale,GOS)分级、临床疗效、低血压发生率及再出血发生率。结果治疗后7、14 d,A组和B组MCA血流速度较C组明显降低(P<0.05),且A组低于B组。治疗后d 28,A组、B组NIHSS评分较C组明显降低(P<0.05),且A组低于B组(P<0.05)。A组、B组治疗有效率明显高于C组(P<0.05),且A组高于B组(P<0.05)。治疗后28 d,B组低血压发生率明显高于A组和C组(P<0.05),但C组和A组间比较差异无统计学意义(P>0.05);3组再出血率比较差异无统计学意义(P>0.05)。治疗后3个月,A组、B组GOS分级明显优于C组(P<0.05),且A组优于B组(P<0.05)。结论经静脉泵注和经导引导管注入长春西汀均可有效治疗颅内动脉瘤栓塞术中CVS,但经导引导管注入长春西汀具有更好的效果和安全性。

Aim To evaluate the efficacy and safety of different routes for vinpocetine injection by intravenous or trans-angiographic catheter on cerebral vasospasm( CVS). Methods A total of 105 aneurysmal subarachnoid hemorrhage( a SAH) patients with CVS following intracranial aneurysm embolization were chosen and randomly divided into group C,B and A,with 35 cases in each group. Patients in group C were treated with 3H therapeutic regimen,while those in group B and A were with 3H therapeutic regimen plus vinpocetine by intravenous injection or trans-angiographic catheter,respectively. The index including middle cerebral artery( MCA) blood flow velocity,National Institutes of Health stroke scale( NIHSS) score,Glasgow outcome scale( GOS) grading,clinical efficacy,hypotension rate and rehaemorrhagia rate were detected and compared among three groups. Results After the 7 d and14 d treatment,the MCA blood flow velocity of group A and B was observed to be significantly lower than that of group C( P < 0. 05),and the MCA blood flow velocity of group A was significantly lower than that of group B( P < 0. 05). The NIHSS score of group A and B was significantly lower than that of group A( P <0. 05),and the score of group A was significantly lower than that of group B( P < 0. 05) following 28 d treatment. Moreover,the clinical efficacy of group A and B was significantly higher than that of group C( P <0. 05),and the clinical efficacy of group A was significantly higher than that of group B( P < 0. 05). After the 28 d treatment,the hypotension rate of group B was found to be significantly higher than that of group C and A( P < 0. 05),while there was no statistical difference( P > 0. 05) observed in the hypotension rate between group A and C. Also,there was no statistical difference( P > 0. 05) found in the rehaemorrhagia rate among three groups. However,the GOS grading of group A and B was significantly better than that of group C( P < 0. 05),and the grading of group A was significantly better than that of group B( P < 0. 05) after3 months treatment. Conclusions Using vinpocetine by intravascular injection or by trans-angiographic catheter could be the efficient treatment for the CVS after intracranial aneurysm embolization, and vinpocetine injection by trans-angiographic catheter is the better mode of administration with the consideration of efficacy and safety.