尼莫地平联合盐酸法舒地尔对颅内动脉瘤急性出血期SAC术后脑血管痉挛的影响

摘要

Objective:To evaluate the effect of Nimodipine combined with Fasudil hydrochloride in the treatment of Cerebral vasospasm of intracranial aneurysms after acute hemorrhagic by SAC after operation. Methods:A total of 86 patients with crebral vasospasm of intracranial aneurysms after acute hemorrhagic by SAC were selected and randomly divided into 2 groups,43 cases each. The control group received nimodipine infusion micro pump injection 10mg,tid,the treatment group received nimodipine infusion micro pump injec-tion 10mg,tid,+fasudil hydrochloride micro pump injection 30mg,tid,and 2 groups were treated for 14days. Nerve function defect score (National Institutes of health neurological impairment score, NIHSS), Glasgow coma score (Glasgow Coma Scale,GCS),Barthel (the Barthel index of index ADL) evaluated, blood sam-ples were collected to determine the levels of Fatty acid binding protein(FABP) and Neuron specific enolase (NSE),and blood flow velocity of middle cerebral artery(MCA) were determined and clinical effect were al-so compared. Results: After the treatment, the NIHSS scores in the control group and the treatment group were (10.97±3.98),(7.61±3.86),GCS scores were(11.19±2.85),(13.56±3.04) Barthel scores were re-spectively (48.37±11.24),(59.68 ± 12.30), levels of FABP (521.23 ± 118.75), (397.02 ± 97.45) ng/L, NSE were respectively(14.82±3.71),(11.64±3.59) ug/L,MCA were respectively(123.20±21.14),(138. 69±21.36) cm/s,the above indexes in the control group and treatment group had statistical significance(P<0.05),the total efficiency of the control group76.74% was lower than the treatment group 93.02%(P<0.05), and the incidence of cerebral infarction within 30 days in the control group18.60% was higher than the treat-ment group 4.65%(P<0.05). Conclusion:Nimodipine combined with fasudil hydrochloride can relieve cere-bral vasospasm of intracranial aneurysms after acute hemorrhagic by SAC, reduce neurological damage, pro-mote brain perfusion,is worthy of clinical application.%目的:探讨尼莫地平联合盐酸法舒地尔对颅内动脉瘤急性出血期 SAC 术后脑血管痉挛的影响.方法:选择我院符合标准的86例颅内动脉瘤急性出血期行支架辅助栓塞治疗术(stent-assist-edcoiling,SAC)后出现脑血管痉挛患者,随机分为对照组和观察组,各43例,对照组给予尼莫地平微泵持续输注,10mg,tid,观察组给予尼莫地平微泵持续输注10mg/次,tid+盐酸法舒地尔微泵持续输注, 30mg,tid,治疗时间为14d.治疗期间对神经功能缺损评分(National Institutes of health neurological im-pairment score,NIHSS)、Glasgow昏迷评分 (Glasgow Coma Scale,GCS)、Barthel 指数评分(the Barthel in-dex of ADL)评定,采血测定脂肪酸结合蛋白(Fatty acid binding protein,FABP)、神经特异性烯醇酶(Neu-ron specific enolase,NSE)数值,测定大脑中动脉血流 (middle cerebral artery, MCA),同时比较两组患者治疗效果.结果:NIHSS评分(10.97±3.98 vs 7.61±3.86),GCS 评分(11.19±2.85 vs13.56±3.04),Barthel指数(48.37±11.24 vs 59.68±12.30),FABP 为(521.23±118.75 vs 397.02±97.45)ng/L,NSE分别为(14.82 ±3.71 vs 11.64±3.59)ug/L,MCA分别为(123.20±21.14vs138.69±21.36)cm/s,对照组上述指标与观察组比较,有统计学意义(P<0.05);对照组总有效率76.74%低于观察组总有效率93.02%(P<0.05);对照组30d内脑梗死发生率18.60%高于观察组4.65%(P<0.05).结论:尼莫地平联合盐酸法舒地尔有助于缓解颅内动脉瘤急性出血期SAC术后脑血管痉挛,降低神经功能损伤,促进脑血流灌注,值得临床广泛推广.