尼莫地平对重型脑外伤患者脑血流动力学参数的影响

目的观察钙拮抗剂尼莫地平对重型颅脑损伤患者脑血流动力学参数(CVDI)的影响和指导尼莫地平的临床应用。方法选择80例重型颅脑损伤患者,按照完全随机设计分为2组。常规治疗组接受开颅手术、止血、脱水、抗炎、激素等综合治疗;尼莫地平治疗组在常规治疗的同时,加用尼莫地平治疗,连续用药达伤后30 d。采用CVA LH-450型脑血流动力学检测仪观察伤侧颈动脉血流平均速度(Vmean)、平均血流量(Qmean)、脑血管阻力和动态血管阻力。结果严重脑外伤后Vmean、Qmean明显下降,脑血管阻力与动态血管阻力明显升高。尼莫地平治疗组的上述指标均比常规治疗组有提前改善,两组有显著差异(P<0.01)。而且尼莫地平治疗组的预后明显好于常规治疗组。结论尼莫地平具有改善重型颅脑损伤患者脑血液循环及预后的作用。

Effects of nimodipine on the cerebrovascular hemodynamics in patients with severe head injuries

Objective To observe the effects of calcium-antagonist nimodipine on the cerebrovascular hemodynamic indices (CVHI) in patients with severe head injuries, thereby to facilitate the clinical application of this drug. Methods Eighty patients with severe head injuries were randomly divided into two groups: one group received conventional therapy, including cran-iotomy, hemostasis, dehydration, anti-infection and corticosteroid administration and the other group received nimodipine on the basis of conventional therapy lasting till 30 d after injuries. CVHI, including mean blood flow velocity (V mean ), mean blood flow (Q mean ) in the carotid artery on the injured side, resistance (R) and dynamic resistance (DR) of cerebral vessels, were mea-sured by CVA LH-450 cerebrovascular hemodynamics analyzer (Fudan University, Shanghai, China). Results Obvious reduc-tion in V mean and Q mean with marked increase in R and DR occurred after severe head injury. The indices of nimodipine group were significantly improved and the patients had better prognosis in comparison with conventional therapy group. Conclusion Ni-modipine is effective in promoting cerebral circulation and improving the prognosis of patients with severe head injuries.