动脉瘤介入术后予尼莫地平动脉内灌注治疗蛛网膜下腔出血后脑血管痉挛的临床研究

摘要

Objective To investigate the effect of arterial nimodipine treatment on cerebral vasospasm after subarachnoid hemorrhage in patients with aneurysm after interventional treatment.Methods 118 cases of aneurysmal subarachnoid hemorrhage cerebral vasospasm were treated as research subjects,and were randomly divided into two groups form February 2012 to October 2015,59 cases in each group.All patients were administered hemostasis,dehydration,absolute bed and other symptomatic and supportive treatment.The observation group,on the basis of conventional symptomatic treatment for aneurysm embolization,were administered interventional carotid arterial nimodipine,the control group based on conventional treatment received the traditional 3H therapy.The imaging changes before and after treatment were compared,and the short-term efficacy and long-term effect were also compared.Results The total effective rate in observation group was 93.22％,were significantly higher than that of the control group (71.19％) (P ＜0.01).The average velocity of MCA after treatment decreased significantly (P＜0.01),and that in observation group decreased more significantly (P＜0.01).The meningeal irritation response rate in observation group after treatment was 79.66％,were higher than that of control group significantly increased (P＜0.01);after followed up for 3 months,there were 91.53 ％ of patients with good prognosis in the observation group,were higher than that of control group 77.97％(P＜0.05).Conclusion The effect of arterial nimodipine treatment on cerebral vasospasm after subarachnoid hemorrhage in patients with aneurysm after interventional treatment can lead to satisfactory short-term and long-term efficacy,and there are fewer adverse reactions and it is safe.%目的 探讨动脉瘤介入术后予尼莫地平动脉内灌注治疗蛛网膜下腔出血后脑血管痉挛的临床效果.方法 选取2012年2月至2015年10月收治的118例动脉瘤性蛛网膜下腔出血后脑血管痉挛患者作为研究对象,采取随机数字表将其分成两组,每组59例.两组患者均给予止血、脱水、绝对卧床等对症支持治疗,观察组在常规对症治疗基础上于动脉瘤介入栓塞术后经颈内动脉灌注尼莫地平,对照组则在常规治疗基础上给予传统3H疗法(稀释血液、扩充血容量、升高血压)治疗.比较两组治疗前后影像学与症状变化情况,同时对比两组患者近期疗效及远期疗效.结果 观察组治疗总有效率为93.22％,明显高于对照组的71.19％(P＜0.01);两组患者治疗后大脑中动脉平均流速均较治疗前有明显下降(P＜0.01),其中观察组较对照组大脑中动脉平均流速下降更为明显(P＜0.01);观察组治疗后脑膜刺激征缓解率为79.66％,高于对照组的50.85％(P＜0.01);观察组患者随访3个月有91.53％的患者预后良好,明显高于对照组的77.97％(P＜0.05).结论 动脉瘤介入术后予尼莫地平动脉内灌注治疗蛛网膜下腔出血后脑血管痉挛可取得满意的近期及远期疗效,且不良反应少而轻微,安全性高.