不同剂量尼莫地平预防蛛网膜下腔出血后迟发性脑血管痉挛的效果观察

Observation on the effectiveness of different doses of nimodipine in preventing delayed cerebral vasospasm after subarachnoid hemorrhage

目的探讨不同剂量尼莫地平预防蛛网膜下腔出血(SAH)后迟发性脑血管痉挛(DCVS)的效果。方法我院神经内科收治的SAH患者117例,根据不同用药剂量方案分为小剂量组(n=57)与大剂量组(n=60)。将患者数据进行倾向性匹配评分,排除混杂因素,两组各获55例患者。对比两组疗效(Hunt-Hess分级法),治疗前后大脑中动脉(MCA)、大脑前动脉(ACA)及大脑后动脉(PCA)收缩峰速度,外周血指标[内皮素-1(ET-1)、一氧化氮(NO)与和肽素],预后情况(格拉斯哥预后量表),DCVS与脑梗死发生情况及药物不良反应。结果大剂量组总有效率高于小剂量组(P<0.05);治疗后,两组脑动脉收缩峰(MCA、ACA、PCA)均显著下降,且大剂量组低于小剂量组(P<0.05);两组ET-1水平下降,且大剂量组低于小剂量组(P<0.05);两组NO、和肽素水平升高,且大剂量组高于小剂量组(P<0.05);大剂量组预后情况显著优于小剂量组,DCVS发生率显著低于小剂量组(P<0.05);两组脑梗死发生率、药物不良反应发生率比较,差异无统计学意义(P>0.05)。结论大剂量尼莫地平治疗效果更佳,可有效缓解患者脑神经压力,促进血液循环,同时可预防DCVS及脑梗死,值得推广。

Objective To explore the effect of different doses of nimodipine in the prevention of delayed cerebral vasospasm(DCVS)after subarachnoid hemorrhage(SAH).Methods One hundred and seventeen patients with SAH admitted to the Department of Neurology of our hospital were included.The patients were divided into a low-dose group(n=57)and a high-dose group(n=60)according to different dosage regimens.The patient data were matched and scored to eliminate confounding factors.Finally,55 patients were obtained in each group.The efficacy(Hunt-Hess grading method),cerebral artery systolic peak velocity of middle cerebral artery(MCA),anterior cerebral artery(ACA)and posterior cerebral artery(PCA),peripheral blood indicators such as endothelin-1(ET-1),nitric oxide(NO)and copeptin,prognosis assessed by Glasgow outcome scale,occurrence of DCVS and cerebral infarction as well as adverse drug reactions were compared between the two groups.Results The total efficacy in the high-dose group was significantly better than that in the low-dose group(P<0.05).After treatment,the cerebral artery systolic peak velocities of MCA,ACA and PCA in the two groups were significantly decreased(P<0.05),and the velocities in the high-dose group were significantly lower than those in the low-dose group(P<0.05).The level of ET-1 in both groups was reduced significantly after treatment,and the level in the high-dose group was significantly lower compared with that in the low-dose group(P<0.05).The levels of NO and copeptin were significantly increased in both groups,and the high-dose group had significantly higher levels compared to the low-dose group(P<0.05).The prognosis was significantly better in the high-dose group than that in the low-dose group(P<0.05).The incidence of DCVS in the high-dose group was significantly lower than that in the low-dose group(P<0.05).There was no statistical significance in the incidence of cerebral infarction between the two groups(P>0.05).There was no statistical difference in the incidence of adverse drug reactions between the two groups(P>0.05).Conclusions High-dose nimodipine has a good therapeutic effect.It can effectively relieve the cerebral nerve pressure,promote the blood circulation,and prevent the DCVS and cerebral infarction.It is worth promoting.