复方右旋糖酐在自发性蛛网膜下腔出血后脑血管痉挛中的应用

Application of compound dextran in cerebral vasospasm after spontaneous subarachnoid hemorrhage

目的分析复方右旋糖酐在自发性蛛网膜下腔出血后脑血管痉挛患者中调节血压、改善血容量、增加脑组织血供及改善临床症状的治疗效果。方法分析我院2018年2月1日至2019年11月1日收治的89例蛛网膜下腔出血后发生脑血管痉挛患者,将患者随机分为实验组(n=46)和对照组(n=43)。在规范化治疗的基础上,两组均予以尼莫地平注射液(一日1次,每次30 mg)治疗,实验组加用复方右旋糖酐40注射液(一日1次,每次250 ml)。两组治疗周期为3~12 d。观察住院期间患者并发症发生情况,比较两组患者一般情况、平均住院天数以及治疗5 d后的拉斯哥预后评分(Glasgow outcome scale,GOS)、收缩压、血红蛋白、血细胞比容(hematocrit,Hct)和不良反应发生情况等。结果两组患者年龄、性别、动脉瘤情况、手术情况、相关疾病史以及入院时收缩压水平和Hunt-Hess分级等一般情况可比(P>0.05)。治疗5 d后,实验组GOS评分和平均收缩压高于对照组,Hct低于对照组,差异均有统计学意义(P<0.05)。两组均有轻微不良反应发生,实验组不良反应发生率为8.70%,对照组则为6.98%,差异无统计意义(P>0.05)。结论尼莫地平联合复方右旋糖酐可改善蛛网膜下腔出血后脑血管痉挛患者出院时的一般状况,同时具有潜在升高血压、稀释血液的作用,且安全性较高。

Objective To analyze the therapeutic effect of compound dextran on cerebral vasospasm after spontaneous subarachnoid hemorrhage by regulating blood pressure,improving blood volume,increasing blood supply to brain tissue and improving clinical symptoms.Methods By analyzing 89 cases of cerebral vasospasm after subarachnoid hemorrhage in our hospital from February 12018 to November 1,2018,the patients were randomly divided into experimental group(n=46)and control group(n=43).On the basis of standardized treatment,both groups were given nimodipine injection(30 mg once a day),and the experimental group was given compound dextran 40 injection(250 ml once a day).The treatment period of the two groups was 3~12 days.The incidence of complications was observed,and the general condition,average length of stay,Glasgow outcome scale(GOS),systolic blood pressure,hemoglobin,hematocrit(HCT),and adverse reactions were compared between the both groups.Results There was no significant difference in age,gender,aneurysm,operation,history of related diseases,systolic blood pressure and Hunt-Hess classification between the both groups(P>0.05).After 5 days of treatment,the GOS and mean systolic blood pressure of the experimental group were higher than those of the control group,and the Hct of the experimental group was lower than that of the control group(P<0.05).Mild adverse reactions occurred in both groups.The incidence of adverse reactions in the experimental group was 8.7%,while that in the control group was 7.0%.The difference was not statistically significant(P>0.05).Conclusion Nimodipine combined with compound dextran can improve the general condition of cerebral vasospasm patients discharged from hospital after subarachnoid hemorrhage,and it has the potential effect of increasing hypertension and diluting blood,with high safety.