尼莫地平静脉应用和术中灌洗对预防血管痉挛作用的临床研究

目的研究尼莫地平围手术期静脉应用以及术中灌洗对动脉瘤破裂致蛛网膜下腔出血患者手术后血管痉挛预防的临床疗效。方法统计我科2005年1月至2009年2月经手术治疗的动脉瘤性蛛网膜下腔出血患者,根据围手术期是否规范使用尼莫地平以及术中是否同时进行术野内灌洗分为3组,分析其与血管痉挛发生率的相关性。结果围手术期规范使用尼莫地平患者术后血管痉挛发生率(23.2%)明显低于未规范使用该药物者(36.3%),P<0.01;术中同时进行灌洗组血管痉挛发生率最低(12.5%),灌洗组与单纯静脉用药组差异有统计学意义(P=0.042)。出现术后严重并发症的发生率静脉用药组为13.7%,同时辅助术中灌洗组为20.0%,而对照组为32.7%。结论围手术期静脉内使用尼莫地平可以有效降低术后血管痉挛的发生率,并减少患者术后严重并发症的发生比例,术中灌洗在一定程度上可以进一步增加这种抗血管痉挛的作用和效果。

Remission effect on vasospasm by using intravenous nimodipine infusion and rinsing with freshly solution

Objective To study the remission effect on vasospasm by using intravenous nimodipine infusion clinically and rinsing with freshly solution during the operation.MethodsThe patients suffered from the subarachnoid hemorrhage and received the operation during Jan 2005 to Feb 2009 were divided into 3 groups,according to whether using intravenous nimodipine infusion clinically,and together with rinsing in operation or not.ResultsThe incidence rate of cerebral vasospasm in intravenous group was 23.2%,compared with the 36.3% in control group,and the statistical difference is positive(P<0.01);the vasospasm occured in 12.5% patients in rinsing group,which was the lowest among the 3 groups,but the statistical difference is not obvious(P=0.042).The occurance of severe complications in 3 groups were 13.7%,20.0% and 32.7% respectively.ConclusionNimodipine is effective in reducing the incidence rate of cerebral vasospasm,and also can prevent severe complications from occuring,while this effect can be enhanced together with rinsing solution in operation.