尼莫地平联合腰大池引流术治疗颅内动脉瘤夹闭术患者的疗效分析

Efficacy analysis of nimodipine combined with lumbar cisterna drainage in the treatment of patients undergoing intracranial aneurysm clipping

目的探讨尼莫地平与腰大池引流术(LD)联合应用对治疗颅内动脉瘤夹闭术患者的临床疗效及安全性。方法选取2014-03-2019-02南阳市中心医院收治的颅内动脉瘤患者80例为研究对象,按照治疗方案将患者随机分为对照组和试验组各40例。2组入院后均及时给予开颅动脉瘤夹闭术及常规治疗,对照组给予微量泵输注30 mg/d尼莫地平并行腰椎穿刺术,试验组给予微量泵输注30 mg/d尼莫地平联合LD,比较2组大脑中动脉血流速度(VMCA)、脑脊液压力及脑脊液中红细胞计数(RBC),记录不同时间节点脑氧供需指标及脑氧饱和度(rSO2),比较2组治疗前后的MMP-9、sICAM-1、sVCAM-1水平及格拉斯哥昏迷(GCS)评分、治疗后的格拉斯哥预后(GOS)评分,并记录治疗过程中不良事件发生情况。结果2组术后3~7 d VMCA水平呈先升高再降低趋势,而脑脊液压力及RBC水平持续降低,且观察组显著低于对照组(P<0.05);T2至T4阶段,2组SjvO2、CjvO2、CaO2呈先升高后降低再升高趋势,且T2、T3时间点试验组显著高于对照组(P<0.05);T2至T4阶段,2组Ca-jvO2、CERO2呈先降低后升高再降低趋势,且T2、T3时间点试验组显著低于对照组(P<0.05);T2至T4阶段,2组rSO2呈先升高再降低趋势,且T2、T3时间点试验组显著高于对照组(P<0.05);术后3 d及术后7 d,试验组MMP-9及sICAM-1、sVCAM-1水平显著优于对照组(P<0.05),术后7 d及术后14 d,试验组GCS水平显著优于对照组(P<0.05),治疗后1个月,试验组GOS评分显著高于对照组,有显著性差异(P<0.05);治疗过程中,试验组的不良反应发生率显著低于对照组,有显著性差异(P<0.05)。结论CA患者颅内动脉瘤夹闭术后给予尼莫地平联合LD,对改善患者脑氧供需平衡及脑氧饱和度、减轻脑损伤及颅内炎症、减轻血管痉挛、保护脑组织、改善患者近期预后有重要价值。

Objective To investigate the effectiveness and safety of nimodipine combined with lumbar cistern drainage(LD)for patients undergoing intracranial aneurysm clipping.Methods Eighty patients with CA who underwent intracranial aneurysm clipping in our hospital from Mar.2014 to Feb.2019 were randomly divided into observation group and control group,40 cases in each group.Both groups were infused with 30 mg/d of nimodipine through micro-pump.The control group was treated by lumbar puncture and the observation group was treated by LD.The blood flow velocity of middle cerebral artery(VMCA),cerebrospinal fluid pressure and red blood cell count(RBC)in cerebrospinal fluid were compared between the 2 groups.Cerebral oxygen supply and demand indicators and cerebral oxygen saturation(rSO2)at different time points were recorded.Levels of MMP-9,sICAM-1,sVCAM-1,and GCS scores before and after treatment as well as GOS scores after treatment were all observed in 2 groups,the occurrence of ADR was recorded during treatment.Results Levels of VMCA increased firstly and then decreased from 3 days to 7 days after treatment,while cerebrospinal fluid pressure and RBC continued to decrease,and they were lower in the observation group than the control group(P<0.05).The SjvO2,CjvO2 and CaO2 in both groups increased firstly,then decreased and then increased from T2to T4,and they were significantly higher in the observation than the control group at T2and T3(P<0.05).The Ca-jvO2 and CERO2 in both groups decreases firstly,then increased and then decreased from T2 to T4,and they were significantly lower in the observation than the control group at T2 and T3(P<0.05).The rSO2 in both groups increased firstly and then decreased from T2 to T4,and it was significantly higher in the observation than the control group at T2 and T3(P<0.05).Levels of MMP-9,sICAM-1 and sVCAM-1 in the observation group were significantly lower than those in the control group at 3 days and 7 days after treatment(P<0.05),GCS scores in the observation group were significantly higher than those in the control group at 3 days and 7 days after treatment(P<0.05)as well as GOS scores after one month treatment,the incidence of ADR in observation group was significantly lower than control group,with statistical significance(P<0.05).Conclusion The treatment with nimodipine combined with LD for patients with CA after intracranial aneurysm clipping is of great value in improving cerebral oxygen supply and demand balance and cerebral oxygen saturation,relieving brain injury and intracranial inflammation,protect cerebral tissue and improve short-term prognosis with good safety.