法舒地尔辅助尼莫地平对脑动脉瘤栓塞术后脑血管痉挛血流动力学和脑脊液指标的影响

Effects of Fasudil Plus Nimodipine on Hemodynamics and Cerebrospinal Fluid Indexes in Cerebral Vasospasm after Embolization of Intracranial Aneurysm

目的探究法舒地尔辅助尼莫地平治疗脑动脉瘤栓塞术后脑血管痉挛对脑血流动力学、脑脊液指标及预后的影响。方法选取2014年1月-2017年12月于我院神经外科行动脉栓塞治疗并术后发生脑血管痉挛的病人80例。采用随机数字法分为观察组(40例)和对照组(40例),对照组单用尼莫地平,观察组在此基础上辅以法舒地尔。比较两组治疗前后大脑中动脉(MCA)、大脑后动脉(PCA)的血流速度、脑脊液S100蛋白及血清神经元特异化烯醇化酶(NSE)水平,评估格拉斯哥昏迷(GCS)评分、Barthel指数及神经功能缺损(NFI)评分,统计用药期间不良反应发生率、术后30 d脑梗死发生率。结果治疗前,两组MCA与PCA平均血流速度比较差异无统计学意义(P>0.05),治疗后两组MCA及PCA平均血流速度均减低,且观察组减低更明显,差异有统计学意义(P<0.05)。两组治疗前脑脊液S100蛋白及血清NSE水平比较差异无统计学意义(P>0.05),治疗后两组脑脊液S100蛋白及血清NSE水平降低,观察组低于对照组,差异有统计学意义(P<0.05)治疗前两组GCS、Barthel指数及NFI评分比较差异无统计学意义(P>0.05),治疗后观察组GCS、Brthel指数评分高于对照组,NFI评分低于对照组,差异有统计学意义(P<0.05)。观察组与对照组不良反应发生率分别为10.0%和7.5%,差异无统计学意义(χ^2=0.157,P=0.692)。观察组与对照组术后30 d脑梗死发生率分别为2.5%和15.0%,差异有统计学意义(χ^2=4.305,P=0.038)。结论法舒地尔联合尼莫地平治疗动脉瘤栓塞术后脑血管痉挛可有效改善脑血流状态,促进神经功能恢复,预防脑梗死。

Objective To explore the effects of fasudil plus nimodipine on cerebral hemodynamics,cerebrospinal fluid(CSF) index and prognosis in cerebral vasospasm(CVS) after embolization of intracranial aneurysm(ICA).Methods Eighty patients with CVS after embolization of ICA in department of neurosurgery from January 2014 to December 2017 were randomly divided into two groups:the control group(n=40) treated with nimodipine,and the observation group(n=40) treated with fasudil plus nimodipine.The blood flow velocity,CSF S100 protein and serum neuron-specific enolase(NSE) levels in the middle cerebral artery(MCA) and posterior cerebral artery(PCA) were compared between the two groups before and after treatment.The scores of Glasgow Coma Scale(GCS),Barthel index(BI) and Nerve Function Impairment(NFI) were evaluated.The incidences of adverse reactions during the drug use period and the incidence of cerebral infarction 30 days after operation were observed.Results There was no significant difference in the mean blood flow velocity of MCA and PCA between the two groups before treatment(P>0.05).After treatment,the mean blood flow velocity of MCA and PCA decreased in two groups,which were lower in the observation group than that in the control group(P<0.05).There was no significant difference in the CSF S100 protein and serum NSE levels between the two groups before treatment(P>0.05).After treatment,the CSF S100 protein and serum NSE levels decreased in two groups,which were lower in the observation group than that in the control group(P<0.05).There was no significant difference in the scores of GCS,BI and NFI between the two groups before treatment(P>0.05).After treatment,the GCS and BI scores of the observation group were significantly higher than those of the control group,while the NFI score was lower than that of the control group(P<0.05).The incidence of adverse reactions were 10.0% in the observation group,and 7.5% in the control group,respectively,and the difference was not statistically significant(χ^2=0.157,P=0.692).The incidence of cerebral infarction was 2.5% in the observation group and 15.0% in the control group at 30 days after operation,respectively,and the difference was statistically significant(χ^2=4.305,P=0.038).Conclusion Fasudil and nimodipine can effectively improve cerebral blood flow,promote neurological recovery,and prevent cerebral infarction in patients with CVS after embolization of ICA.