法舒地尔联合腰大池持续引流预防蛛网膜下腔出血后脑血管痉挛的效果

Effects of continuous lumbar cistern drainage combined with fasudil in prevention of cerebral vasospasm after subarachnoid hemorrhage

目的探讨法舒地尔联合腰大池持续引流预防蛛网膜下腔出血后脑血管痉挛的效果。方法选取辽宁省某医院2018年1月-2019年4月收治的93例颅内动脉瘤破裂引起的蛛网膜下腔出血患者为研究对象,采用随机数字表法分为对照组(46例)和观察组(47例)。对照组患者给予颅内动脉瘤夹闭术和常规对症支持治疗及腰大池持续引流,观察组患者在对照组基础上给予法舒地尔治疗,比较2组患者脑血管痉挛发生情况,不同时间点脑脊液压力和脑脊液红细胞计数、脑CT灌注成像相关参数,治疗前后血清基质金属蛋白酶(MMP-9)和S-100钙结合蛋白B(S-100B)水平、美国国立卫生研究院卒中量表(NIHSS)评分。结果 2组患者脑脊液压力和脑脊液红细胞计数随着治疗时间增加逐渐减小,组内不同时间点脑脊液压力和脑脊液红细胞计数比较,差异有统计学意义(P<0.05);但2组患者不同时间点脑脊液压力和脑脊液红细胞计数比较,差异均无统计学意义(P>0.05)。2组患者治疗3d时的脑血容量(CBV)及脑血流量(CBF)比较,差异无统计学意义(P>0.05);观察组患者治疗7d时和治疗14d时的CBV及CBF均高于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者血清MMP-9及S-100B水平比较,差异无统计学意义(P>0.05);治疗后,2组患者血清MMP-9及S-100B水平均低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。观察组患者脑血管痉挛发生率低于对照组,差异有统计学意义(P<0.05)。治疗前,2组患者NIHSS评分比较,差异无统计学意义(P>0.05);治疗后,2组患者NIHSS评分低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。结论在腰大池持续引流基础上加用法舒地尔,可有效预防蛛网膜下腔出血后脑血管痉挛的发生,减轻患者神经功能受损程度,改善患者预后。

Objective To observe the effect of continuous drainage of lumbar cistern combined with fasudil in preventing cerebral vasospasm after subarachnoid hemorrhage.Methods Ninety-three patients with subarachnoid hemorrhage caused by ruptured intracranial aneurysm treated in a hospital in Liaoning from January 2018 to April2019 were enrolled as the research subjects,and subsequently divided into a control group(46 cases)and an observation group(47 cases)by the random number table method.Both groups were treated with intracranial aneurysm clipping,routine symptomatic supportive treatment and continuous lumbar cistern drainage,and the observation group was treated with fasudil in addition.The incidence of cerebral vasospasm and cerebrospinal fluid pressure of the two groups,cerebrospinal fluid red blood cell count and brain CT perfusion imaging related parameters of the two groups at different time points,as well as serum matrix metalloproteinase(MMP-9)and S-100 calcium binding protein(S-100 B)levels and National Institutes of Health Stroke Scale(NIHSS)scores of both groups before and after treatment were compared.Results The cerebrospinal fluid pressure and cerebrospinal fluid red blood cell count of the two groups decreased gradually with the increase of treatment time.There was a statistically significant difference in cerebrospinal fluid pressure and cerebrospinal fluid red blood cell count at different time points in each group(P<0.05),but the difference between the two groups at different time points was insignificant(P>0.05).There was no significant difference in cerebral blood volume(CBV)or cerebral blood flow(CBF)on the 3 rd day of treatment(P>0.05).CBV and CBF of the treatment group on the 7 th day and the 14 th day of treatment were all lower than those of the control group(P<0.05).Before treatment,there was no significant difference in serum MMP-9 and S-100 Blevels between the two groups(P>0.05);the levels of serum MMP-9 and S-100 Bin both groups decreased after treatment,and those of the observation group were significantly lower than those of the control group(P<0.05).The incidence of cerebral vasospasm in the observation group was lower than that in the control group(P<0.05).Before treatment,there was no significant difference in NIHSS scores between the two groups(P>0.05);the NIHSS scores of both groups decreased after treatment,and those of the observation group were significantly lower than those of the control group(P<0.05).Conclusion On the basis of continuous lumbar cistern drainage,the additional use of fasudil can effectively prevent cerebral vasospasm after subarachnoid hemorrhage,reduce neurological impairment,and improve patient′s prognosis.