纳美芬与尼莫地平治疗儿童急性外伤性蛛网膜下腔出血后脑血管痉挛疗效比较

Comparison of the clinical efficacy of nalmefene and nimodipine in the treatment of cerebral vasospasm of children with acute traumatic subarachnoid hemorrhage

目的比较纳美芬与尼莫地平治疗儿童急性外伤性蛛网膜下腔出血后脑血管痉挛的临床效果。方法选择2018年2月至2022年2月无锡市儿童医院收治的65例儿童急性外伤性蛛网膜下腔出血患儿为研究对象,按随机数字表法将患儿分为纳美芬组(n=33)和尼莫地平组(n=32)。所有患儿急诊入院后给予脱水、止血、保持呼吸道通畅、抗感染、维持水电解质和酸碱平衡及全身营养支持治疗等常规对症治疗。纳美芬组患儿在上述常规对症治疗的基础上给予盐酸纳美芬注射液0.05~0.10 mg,静脉推注,每日2次,连续治疗10 d。尼莫地平组患儿在上述常规对症治疗的基础上给予尼莫地平注射液15μg·kg^(-1)·h^(-1),持续静脉泵注24 h,连续治疗10 d。比较2组患儿在治疗前及治疗第3、7、10天格拉斯哥昏迷量表(GCS)评分、Lindegaard指数和颅内压。结果纳美芬组和尼莫地平组患儿GCS评分随着治疗时间延长均呈逐渐上升趋势(F=213.219、59.526,P<0.001)。治疗前,2组患儿GCS评分比较差异无统计学意义(P>0.05);治疗第3、7、10天,纳美芬组患儿的GCS评分显著高于尼莫地平组(P<0.05)。纳美芬组和尼莫地平组患儿Lindegaard指数随着治疗时间延长呈逐渐下降趋势(F=802.972、914.436,P<0.001)。治疗前及治疗第3、10天,纳美芬组与尼莫地平组患儿的Lindegaard指数比较差异无统计学意义(P>0.05);治疗第7天,尼莫地平组患儿的Lindegaard指数显著低于纳美芬组(P<0.05)。纳美芬组和尼莫地平组患儿颅内压值随着治疗时间延长呈逐渐下降趋势(F=2570.042、828.963,P<0.001);治疗前,2组患儿颅内压值比较差异无统计学意义(P>0.05);治疗第3、7、10天,纳美芬组患儿颅内压值显著低于尼莫地平组(P<0.05)。结论纳美芬和尼莫地平均能显著预防和减少急性外伤性蛛网膜下腔出血患儿脑血管痉挛的发生,盐酸纳美芬的促醒和降低颅内压作用强于尼莫地平。

Objective To compare the clinical effects of nimodipine and nalmefene in the treatment of cerebral vasospasm of children with acute traumatic subarachnoid hemorrhage.Methods A total of 65 children with acute traumatic subarachnoid hemorrhage admitted to Wuxi Children′s Hospital from February 2018 to February 2022 were selected as the study subjects.The children were divided into the nemetifen group(n=33)and nimodipine group(n=32)using a random number table method.After emergency admission,all children received routine symptomatic treatment such as dehydration,hemostasis,maintaining respiratory patency,anti-infection,maintaining water and electricity balance and acid-base balance,and systemic nutritional support.On the basis of the above conventional symptomatic treatment,the children in the namefene group were given intravenous injection of 0.05-0.10 mg namefene hydrochloride injection,twice a day for 10 consecutive days;the children in the nimodipine group were given nimodipine injection,continuously intravenous infused with 15μg·kg^(-1)·h^(-1) for 24 hours,continuous treatment for 10 days.The Glasgow coma scale(GCS)score,Lindegaard index,and intracranial pressure were compared between the two groups before treatment and on the 3 rd,7 th anD10 th day of treatment.Results The GCS scores of children showed a gradually increasing trend with prolonged treatment time in the nalmafene group and nimodipine group(F=213.219,59.526;P<0.001).There was no statistically significant difference in GCS scores of children between the two groups before treatment(P>0.05).On the 3 rd,7 th anD_(1)0 th day of treatment,the GCS scores of children in the nalmafene group were significantly higher than those in the nimodipine group(P<0.05).The Lindegaard index of children showed a gradually decreasing trend with prolonged treatment time in the nalmafene group and nimodipine group(F=802.972,914.436;P<0.001).There was no statistically significant difference in Lindegaard index of children between the nalmafene group and the nimodipine group before treatment and on the 3 rd anD10 th day of treatment(P>0.05).On the 7 th day of treatment,the Lindegaard index of children in the nimodipine group was significantly lower than that in the nalmafene group(P<0.05).The intracranial pressure value of children showed a gradually decreasing trend with prolonged treatment time in the nalmafene group and nimodipine group(F=2570.042,828.963;P<0.001).There was no statistically significant difference in intracranial pressure value of children between the two groups before treatment(P>0.05).On the 3 rd,7 th anD_(1)0 th day of treatment,the intracranial pressure value of children in the nalmafene group was significantly lower than that in the nimodipine group(P<0.05).Conclusion Nalmafene and nimodipine can significantly prevent and reduce the occurrence of cerebral vasospasm in children with acute traumatic subarachnoid hemorrhage.The effects of nalmafene for promoting wake-up and reducing intracranial pressure are stronger than those of nimodipine.