尼莫地平与硫酸镁治疗蛛网膜下腔出血后脑血管痉挛的随机对照研究

目的：探讨尼莫地平与硫酸镁治疗蛛网膜下腔出血（SAH）后脑血管痉挛（CVS）的疗效。方法将符合标准的61例SA H后CVS患者分成尼莫地平组（31例）和硫酸镁组（30例），尼莫地平组患者使用尼莫地平进行治疗，硫酸镁组患者使用硫酸镁进行治疗。治疗2周后，采用彩色头颅多普勒检测患者脑血管内血流速度，比较两组患者大脑前动脉（ACA ）、大脑中动脉（MCA ）以及大脑后动脉（PCA ）收缩峰流速（Vp）。对患者的临床症状（头痛、呕吐、脑膜刺激症状）缓解情况及不良反应（血压下降、梗阻性脑积水、再出血、胃肠道出血等）发生情况进行比较。结果硫酸镁组患者左ACA、右ACA、左 MCA以及右 MCA 的 Vp值分别为（81．2±9．1）、（80．8±12．2）、（122．6±20．7）、（118．4±21．6）cm/s，均明显高于尼莫地平组的（70．6±10．2）、（68．6±10．7）、（100．5±16．6）、（101．5±12．7）cm/s （ P＜0．05）；尼莫地平组患者的脑膜刺激征缓解率为77．4％，明显优于硫酸镁组的50．0％（ P＜0．05）；酸镁组患者血压下降发生率显明显低于尼莫地平组（P＜0．05）。结论尼莫地平对SAH引起的CVS具有明显的治疗作用，且其疗效优于硫酸镁，值得临床推广并进一步研究。

Randomized controlled study comparing effect of nimodipine with magnesium sulfate on cerebral vasospasm after sub-arachnoid hemorrhage

Objective To compare the effect of cerebral vasospasm after subarachnoid hemorrhage treated by nimodipine and magnesium sulfate .Methods 61 patients with cerebral vasospasm after subarachnoid hemorrhage were divided into nimodipine group（31 cases） and magnesium sulfate group（30 cases） ,patients in nimodipine group received the treatment of nimodipine ,while others received the treatment of magnesium sulfate .Results The Vp of left and right ACA ,left and right MCA in magnesium sulfate group which were （81 .2 ± 9 .1） ,（80 .8 ± 12 .2） , （122 .6 ± 20 .7） and（118 .4 ± 21 .6）cm/s were significantly higher than that of nimodipine group which were （70 .6 ± 10 .2） ,（68 .6 ± 10 .7） ,（100 .5 ± 16 .6） and（101 .5 ± 12 .7）cm/s（P〈0 .05） .The meningeal stimulation response rate of nimodipine group was 77 .4% ,which was significantly higher than that of magnesium sulfate group which was 50 .0% （P〈 0 .05） .The incidence of complications were also compared between the two groups ,the rate of blood pressure drop in nimodipine group was significantly higher than that in magnesium sulfate group （P〈0 .05） .Conclu-sion Nimodipine has significantly therapeutic effect in treatment of CVS caused by SA H ,and its curative effect is better than magnesium sulfate .nimodipine has good safety and easy use .It is worthy of clinical promotion and further study .