症状性脑血管痉挛的动脉内法舒地尔治疗

Intra-Arterial Infusion of Fasudil as a Treatment of Symptomatic Vasospasm Following SAH

目的:评价盐酸法舒地尔选择性脑动脉内滴注,治疗蛛网膜下腔出血后症状性脑血管痉挛的即时影像学改变和临床疗效。方法:回顾性分析动脉瘤性蛛网膜下腔出血后出现症状性脑血管痉挛的20例患者,介入手术治疗后常规给予“3H”治疗 + 尼莫地平治疗,出现症状性脑血管痉挛后予以造影评估并动脉内法舒地尔滴注治疗,观察治疗前后影像学及症状变化,治疗前后进行NIHSS评分,并随访3个月后行GOS评分,评价远期疗效。结果:NIHSS评分在法舒地尔治疗前后有显著差异(P = 0.03);法舒地尔动脉内滴注后23例次造影图像均有改善(100%),完全缓解19例次(74%);3个月随访,恢复良好比例占85%;法舒地尔滴注治疗中无一例患者出现严重并发症。结论:法舒地尔动脉内滴注治疗,对蛛网膜下腔出血后症状性脑血管痉挛患者有较好的临床疗效及远期预后,控制法舒地尔剂量和给药速率,治疗安全,疗效可靠。

Objective: We investigated the clinical efficacy and safety of intra-arterial administration of fasudil hydrochloride for symptomatic cerebral vasospasm. Methods: 20 cases of symptomatic cerebral vasospasm following subarachnoid hemorrhage (SAH) were retrospectively analyzed. All cases received “3H” + nimodopine therapy and intra-arterial fasudil treatment when the sympomatic vasospasm occurs. Comparison of clinical data between per- and post-therapy and the Glasgow Outcome Scale (GOS) after 3 months were done by statistical analysis. Results: The study showed angiographic improvement in all occasions and better NIHSS scale of per- and post-therapy (P = 0.03). The complete dilation of vasospasm was achieved in 19 occasions (74%). At 3-month fol-low-up, 85% patients showed good recovery on GOS. None severe complications occurred during the fasudil administration. Conclusion: The intra-arterial administration of fasudil therapy was effective for patients with symptomatic vasospasm after subarachnoid hemorrhage. When using a suitable dosage and velocity, the treatment was safe and reliable.