法舒地尔联合丁苯酞对老年颅内动脉瘤血管内治疗后血管痉挛的影响

目的：探讨丁苯酞联合法舒地尔对老年颅内动脉瘤血管内治疗后血管痉挛（cerebral vasospasm，CVS）的影响。方法：选择2017年2月至2019年6月在海南医学院第一附属医院行颅内动脉瘤血管内治疗后CVS患者97例进行回顾性分析。根据患者接受治疗方案的不同将其分为2组，单独给药组47例在常规治疗方案基础上加以法舒地尔，联合用药组50例则在常规治疗方案的基础上加用法舒地尔联合丁苯酞治疗。比较2组患者临床疗效、脑神经相关因子、脑血流动力学指标及不良反应。结果：联合用药组患者总有效率为90.00%，高于单独给药组的74.46%（P<0.05）。治疗前2组患者S100β、NSE、BDNF差异无统计学意义（P>0.05），治疗后2组患者S100β及NSE水平均明显下降，且联合用药组低于单独用药组，治疗后2组患者BDNF水平均明显升高，且联合用药组高于单独用药组（P<0.05）。治疗前2组患者大脑前动脉、大脑中动脉及大脑后动脉血流速度差异无统计学意义（P>0.05），治疗后2组患者大脑前动脉、大脑中动脉及大脑后动脉血流速度均明显升高，且联合用药组高于单独用药组（P<0.05）。本研究中不良反应均为轻度，在对症治疗或停药处理后均得到控制。单独用药组患者共发生5例（10.64%）不良反应，与联合用药组的6例（12.00%）比较差异无统计学意义（P>0.05）。结论：常规治疗基础上加丁苯酞可有效改善脑神经功能及降低脑血流速度、提高老年颅内动脉瘤血管内治疗后CVS患者临床疗效。安全性未见明显不同。

Effect of fasudil plus butylphthalide on cerebral vasospasm after endovascular treatment of senile intracranial aneurysm

OBJECTIVE To explore the effect of butylphthalide plus fasudil on cerebral vasospasm(CVS)after endovascular treatment of senile intracranial aneurysms.METHODS A retrospective analysis was performed for 97 CVS elders treated for intracranial aneurysm from February 2017 to June 2019.Based upon treatment protocol, they were divided into two groups of single drug(fasudil alone, n=47)and combination(fasudil plus butylphthalide, n=50).Clinical efficacy, neurological function, cerebral hemodynamics and adverse reactions were compared between two groups.RESULTS The overall effective rate was higher in combination group than that in single drug group(90.00% vs 74.46%,P<0.05).Prior to treatment, no significant inter-group differences existed in S100 β,neuron specific enolase(NSE)or brain-derived neurotrophic factor(BDNF)(P>0.05).The levels of S100 β and NSE of two groups decreased markedly and combination group was lower than single drug group.After treatment, the level of BDNF rose markedly in two groups and combination group was higher than single drug group(P<0.05).Prior to treatment, no significant inter-group differences existed in blood flow velocity of anterior/middle cerebral artery/posterior cerebral artery(P>0.05).After treatment, blood flow velocity of anterior/middle/posterior cerebral artery increased significantly in two groups and combination group was higher than single drug group(P<0.05).All adverse reactions were mild and were controlled after symptomatic treatment or withdrawal.A total of 5(10.64%)adverse reactions occurred in single drug group and it was not significantly different from 6(12.00%)in combination group(P>0.05).CONCLUSION An addition of butylphthalide on the basis of conventional treatment can effectively improve brain nerve function and reduce cerebral blood flow speed to improve the clinical efficacy of CVS elders after endovascular treatment of intracranial aneurysms.There is no significant difference in safety.