尼莫地平对动脉瘤性蛛网膜下腔出血脑血管痉挛的临床疗效研究

目的:观察尼莫地平对动脉瘤性蛛网膜下腔出血脑血管痉挛的临床疗效及安全性,为临床治疗提供依据。方法:对我院2010年2月~2013年2月期间收治的92例动脉瘤性蛛网膜下腔出血患者进行随机分为观察组和对照组,每组46例。两组患者入院后均进行常规治疗,绝对卧床休息、镇静、给予氨甲环酸止血、脱水降颅压、防治感染及对症治疗。观察组在上述治疗基础上给予尼莫地平(德国拜尔公司)持续微泵静脉注射20 mg·d-1,连用14 d,后改为口服尼莫地平片40 mg,qid,至第21天,根据监测血压调整剂量。观察两组患者1个月内脑血管发病情况、CT评价情况,并进行对比分析。结果:两组患者治疗后,观察组有效率91.3%;对照组有效率73.91%。两组比较差异明显,观察组疗效明显优于对照组,具有统计学意义(P0.05)。两组患者在治疗期间,观察组发生脑血管痉挛4例,占8.7%;对照组发生脑血管痉挛26例,占56.52%,两组比较差异明显,具有统计学意义(P0.05)。结论:尼莫地平能够显著降低动脉瘤性蛛网膜下腔出血脑血管痉挛的发生率,对脑血管再出血具有积极防治作用,建议推广应用。

Study on Clinical Effect of Nimodipine on Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage

Objective： To observe the clinical efficacy and safety of nimodipine on cerebral vasospasm after aneurysmal subarachnoid hemorrhage, and to provide basis for clinical therapy. Methods： 92 cases of patients with aneurysmal subarachnoid hemorrhage in our hospital from February 2010 to February 2013 were randomly divided into observation group and control group, each with 46 cases. Two groups of patients received conventional treatment, absolute bed rest, sedation, given tranexamic acid hemostasis, lowering the intracranial pressure, prevention of infection and symptomatic treatment. In addition to the above treatment, the observation group received 20mgod^-1 of nimodipine （Bayer company） continued micro-pump infusionfor 14 days, and then oral nimodipine tablets 40 mg, qid, until the 21st day, and the dose was adjusted according to the blood pressure monitored. Mobidity of cerebral vascular and evaluation of CT were observed and contrastively analyzed. Results： After treatment, effective rates of the observation group and the control groups were 91.3% and 73.91% respectively, with significant difference. Clinical efficacy of the observation group was significantly superior that that of the control group, with statistical significance （P〈0.05）. During the treatment, there were 4 cases （8.7%） of cerebral angiospasm in the observation group, and 26 cases （56.52%） in the control group, with statistically significant difference （P〈0. 05）. Conclusion： Nimodipine can significantly reduce the occurrence rate of cerebral vasospasm after aneurysmal subarachnoid hemorrhage, and has a positive role in the prevention of cerebral vascular hemorrhage, thus is worthy of popularization and application.