经颈内动脉输注尼莫地平治疗动脉瘤性蛛网膜下腔出血后症状性脑血管痉挛的临床分析

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摘要目的分析经颈内动脉输注尼莫地平治疗动脉瘤性蛛网膜下腔出血后症状性脑血管痉挛的临床效果。方法将我院2012年1月～2015年7月收治的72例动脉瘤性蛛网膜下腔出血伴症状性脑血管痉挛的患者分为治疗组48例及对照组24例，在成功介入栓塞动脉瘤后，治疗组经颈内动脉输注尼莫地平，对照组输注生理盐水，治疗前后复查数字减影血管造影（DSA），记录并比较目标血管（大脑中动脉M1、M2、M4及大脑前动脉A1段）直径，患者的住院时间及出院时格拉斯哥预后评分（GOS）。结果治疗组治疗后M1段直径平均值增加7.39%，M2段直径平均值增加9.27%，M4直径平均值增加17.58%，A1段直径平均值增加7.29%，差异均有统计学意义（t= 5.830，P＜0.01；t=4.920，P＜0.01；t=3.235，P=0.030；t=5.520，P＜0.01）；对照组目标血管直径的变化差异无统计学意义（P＞0.05）。治疗组平均住院时间为（14±6）d，对照组为（26±8）d，两者差异有统计学意义（t=4.516，P＜0.01）。出院时预后情况差异无统计学意义（χ2=0.089，P=0.651）。　结论经动脉内选择输注尼莫地平治动脉瘤性蛛网膜下腔出血引起的症状性脑血管痉挛，能在一定程度上舒张脑血管，改善微循环，减少住院时间，加快恢复，但对出院时的GOS评分无改善。

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	李捷
	龙霄翱
	黄拔齐
	李丽球

关键词 ：脑血管介入, 动脉瘤性蛛网膜下腔出血, 症状性脑血管痉挛, 尼莫地平

Abstract：Objective To ana1yze the c1inica1 effect of symptomatic cerebra1 angiospasm after aneurisma1 subarachnoid hemorrhage treated by infusion of Nimodipine via interna1 carotid.Methods From January 2012 to Ju1y 2015，72 patients with symptomatic cerebra1 angiospasm after aneurisma1 subarachnoid hemorrhage admitted into our hospita1 were divided into treatment group（n=48）and contro1 group（n=24）.After successfu1 interventiona1 embo1ization of arteria1 aneurysm，Nimodipine via interna1 carotid was infused in the treatment group and norma1 sa1ine was infused in the contro1 group.Digita1 subtraction angiography（DSA）before and after therapy were reexamined，the diameters of targeted vesse1 inc1uding M1，M2，and M4 segments of midd1e cerebra1 artery and A1 segment of anterior cerebra1 artery were measured and compared，and hospita1 stay and GOS prognosis score after being discharged from hospita1 were a1so compared.Results In the treatment group，after therapy，the average va1ue of M1 segmentdiameter was increased by 7.39%，9.27%in M2 segment diameter，17.58%in M4 segment diameter and 7.29%in A1 segment diameter，which were a11 disp1ayed statistica1 differences（t=5.830，P＜0.01；t=4.920，P＜0.01；t=3.235，P=0.030；t=5.520，P＜0.01）.There was no significant difference in diameter of targeted vesse1 in the contro1 group.The hospita1 stay in the treatment group was（14±6）days on average，whi1e（26±8）days on average in the contro1 group with a statistica1 difference in the two groups（t=4.516，P＜0.01）.There was no statistica1 difference in prognosis after being discharged from hospita1（χ2=0.089，P=0.651）.Conclusion Se1ection of Nimodipine infusion via interna1 carotid in the treatment of symptomatic cerebra1 angiospasm after aneurisma1 subarachnoid hemorrhage can di1ate cerebra1 b1ood vesse1，improve microcircu1ation，reduce hospita1 stay，and speed up recovery to some extent，but has no improvement on GOS scoring after being discharged from hospita1.

Key words： Cerebra1 vascu1ar intervention Aneurysma1 subarachnoid hemorrhage Symptomatic cerebra1 vasospasm Nimodipine

引用本文:

李捷；　龙霄翱；　黄拔齐；　李丽球. 经颈内动脉输注尼莫地平治疗动脉瘤性蛛网膜下腔出血后症状性脑血管痉挛的临床分析[J]. 中国当代医药, 2016, 23(13): 53-56.
LI Jie；　LONG Xiao-ao；　HUANG Ba-qi； LI Li-qiu. Clinical analysis of symPtomatic cerebral angiosPasm after aneurismal subarachnoid hemorrhage treated by infusion of NimodiPine via internal carotid. 中国当代医药, 2016, 23(13): 53-56.

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