长托宁治疗蛛网膜下腔出血后血管痉挛疗效分析

目的研究长托宁（盐酸戊乙喹醚注射液）对动脉瘤破裂后蛛网膜下腔出血并发脑血管痉挛的治疗作用。方法对22例动脉瘤破裂后蛛网膜下腔出血并发脑血管痉挛患者,动静脉联合应用长托宁14d,经脑血管造影、血液动力学及神经行为学评价长托宁疗效。结果动脉内应用长托宁使血管扩张达（53±37）%（P〈0.01）,有轻度心率增快,但对全身动脉压未产生明显影响。22例患者中2例死亡,2例失访,余18例在1年内恢复较好改良等级评分：（0.8±1.0）分;巴塞尔指数：100（95～100）]。5例患者在动脉注射长托宁后48h内脑血管痉挛复发（23%）,其中2例再次动脉给予长托宁后好转,另3例行腔内气囊血管成形术。结论长托宁能安全有效治疗动脉瘤破裂后蛛网膜下腔出血并发的脑血管痉挛。

Analysis on the effect of penehyclidine hy drochloride on CVS secondary to aSAH

Objective To assesse the efficacy and tolerance of penehyclidine hydrochloride in patients with cerebral vasospasm （CVS） secondary to aneurysmal subarachnoid hemorrhage （aSAH）. Methods 22 consecutive patients with anglo-graphically-proven CVS have been studied. Intraarterial penehyclidine hydrocbloride was infused in the cerebral territory（ies） involved and followed by continuous intravenous infusion until Day 14 after initial bleeding. Evaluated angiographic reversal of CVS, hemodynamic tolerance, and neurological outcome 1 year after aSAH. Results Intraarterial penehyclidine hydrochloride resulted in （53 ± 37 ）% increase in arterial diameter（ P 〈 0.01 ）. Penehyclidine hydrochloride infusion resulted in moderately increased heart rate, but systemic arterial pressure remained unchanged. 2 patients died in ICU, and 2 were lost to follow-up. All other patients had very good neurological outcome modified Rankin scale ： （0.8 ± 1.0 ） ; Barthel index ： 100 （ 95 - 100） ]. 5 patients（23% ） had angiographically-proven vasospasm recurrence within 48 hours after the procedure. 2 of them were successfully reversed after another intraarterial infusion of penehyclidine hydrochloride. The remaining 3 underwent mechanical angioplasty. Conclusion Penehyclidine hydrochloride is effective and safe for reversal of CVS ＇after aSAH and should be tested in a large randomized trial.