出血性动脉瘤栓塞术后血管痉挛的预防与治疗

目的研究探讨出血性脑动脉瘤栓塞术后脑血管痉挛的防治方法。方法选择我院2006年1月至2011年1月收治的110例出血性脑动脉瘤患者作为观察对象,将所有患者随机分为治疗组与对照组,分组具有组间均衡性,并采用脑动脉瘤栓塞急诊术治疗,术后均采用脱水、降压,解痉等支持治疗。治疗组术后蛛网膜下腔置管持续引流+静脉泵入尼莫地平(2～4mL/h),14d后改为口服尼莫地平,对照组术后静脉泵入尼莫地平(2～4mL/h),14d后改为口服尼莫地平。结果两组于术后3个月时进行GOS评分,治疗组89%患者恢复良好,随访无死亡病例;对照组3例死亡,60%患者恢复良好,两组治疗结果具有显著差异性(P<0.01)。结论栓塞术后使用蛛网膜下腔置管持续引流效果比单纯使用尼莫地平治疗效果好,蛛网膜下腔置管持续引流能及时有效排出血性脑积液,大大减轻了血性脑积液对脑血管的刺激,有效预防和减轻了血管痉挛,改善了预后。

Prevention and Treatment on Cerebral Vasospasm after Emergency of Ruptured Intracranial Aneurysm

Objective In order to find the measure on preventing and treating cerebral vasospasm after emergency of ruptured intracranial aneurysm.Method Select 110 cases after suffered intracranial aneurysm1] were treated by endovascular embolization in our hospital from Jan 2006 to Jan 2011 which was divided into 2 groups who were given the same traditional treatment,whereas study group was treated with papaverine continuously for 10 days;while control group injected nimodipine for 14 days.Result There is significantly difference between rate of patients＇ good recovery（P〈0.01）.Conclusion Pumping with papaverine continuously after endovascular embolization for patients with intracranial aneurysm has a great clinical effect on preventing cerebral vasospasm.