【作者】 于莹；

【导师】 赵丛海；

【作者基本信息】 吉林大学 ， 外科学， 2006， 硕士

【摘要】 脑血管痉挛一直被认为是蛛网膜下腔出血后严重的并发症,是致残和死亡的主要原因。尼莫地平是目前较为肯定的防治CVS的药物。本文通过前瞻性研究,旨在观察尼莫地平防治动脉瘤性蛛网膜下腔出血后CVS的疗效,对比尼莫地平不同给药途径在疗效上的差异,总结尼莫地平防治aSAH后CVS的经验。选取吉林大学中日联谊医院神经外科2004年-2006年期间收治的27例颅内动脉瘤破裂后SAH患者,按照尼莫地平给药途径不同随机分为局部给药、全身给药和对照组,以TCD监测大脑中动脉、颈内动脉血流速度,结合患者临床资料进行综合分析。结果显示三组间治疗前后MCA血流速度变化比较。局部给药组术后前2天、术后第14天与手术前相比血流速度无明显变化;全身给药组术后第1天、术后5-7天、第10天、第14天与手术前相比血流速度无明显变化。三组间治疗前后MCA/ICA变化情况与治疗前后MCA血流速度变化情况基本一致。全身给药组治疗后与治疗前相比收缩压、舒张压明显下降。全身给药组治疗后7例中有3例ALT、AST异常。局部给药组颅内感染2例。通过研究得出以下结论:1. TCD由于具有经济、无创伤、实时、可重复连续监测、灵敏度和特异更多还原

【Abstract】 Object: To observe the effect of Nimodipine on preventionand treatment of cerebral vasospasm after aneurysmalsubarachnoid hemorrhage, to evaluate the differences amongthe cohorts treated by Nimodipine with various administrationroutes, and to summarize the experience of prevention andtreatment of cerebral vasospasm after aneurysmalsubarachnoid hemorrhage. We screened 27 cases ofaneurysmal subarachnoid hemorrhage for this prospectivestudy.Methods: We randomly classified all of the 27 patientsinto three groups: local administration group, totaladministration group and control group. We compared thefollowing factors among these three groups: age, Hunt-Hessscale, improved Fisher’ scale, the changes of intracranialvascular blood flow rate by transcranial Doppler’s monitoring,the changes of blood pressure, intracranial infection, thechanges of liver function, nervous functional status atdischarge and the follow-up results after three months.Result: There isn′t significant difference in age,Hunt-Hess scale, improved Fisher’ scale among the threegroups. There isn′t significant difference in nervous functionalstatus at discharge and the follow-up results after three monthsamong the three groups. The post-treatment systolic bloodpressure and diastolic blood pressure in total administrationgroup have a significant decrease. While the patients in localadministration group and control group haven′t significantdifference in blood pressure before and after treatment. Wecompare the middle cerebral artery blood flow velocity amongthe three groups. The patients in local administration grouphaven’t significant difference in post-operation blood flow of thefirst 2 days and the fourteenth day compared with thepre-operation data, but there is significant blood flow velocityaccelerating in 3-7 days and the tenth day post-operation. Thepatients in total administration group haven’t significantdifference in the first day, 3-7 days, the tenth day and thefourteenth day post-operation compared with the pre-operationdata, but there is significant blood flow velocity accelerating in2-4 days. The patients in control group haven’t significantdifference in the fourteenth day post-operation compared withthe pre-operation data, but there is significant blood flowvelocity accelerating in the first 7 days and the tenth daypost-operation. The changes of blood flow velocity ratio ofMCA/ICA before and after treatment is fundamentallyconsistent with the middle cerebral artery blood flow velocity.There are 3 cases liver function abnormity in 7 cases of totaladministration group, respective data being ALT 75 U/L, AST89U/L, ALT 95 U/L, AST 76 U/L, ALT 107 U/L, AST 81U/L, butthere aren’t any cases liver function abnormity in localadministration group and control group. There are 2 cases liverfunction abnormity in 10 cases of local administration group,but there aren’t any cases liver function abnormity in totaladministration group and control group.Conclusion: 1. For the advantage of economy,noninvasion, real time, repeat continuum inspect and highersensitivity and specificity, TCD can determine CVS with thepatient′s neurological symptom. 2. Nimodipine administratedlocally or totally can availably prevent and treat of cerebralvasospasm after aneurysmal subarachnoid hemorrhage, andefficiently reduce the rate of CVS occurring compared withpapaverine. 3. Nimodipine preventing and treating of cerebralvasospasm after aneurysmal subarachnoid hemorrhage bylocal administration route, operates early compared with totaladministration, can be used in short time after operation. Thedosage of local cerebral cisterna administrating Nimodipineafter operation still need following study. 4. Nimodipineadministrated locally and totally in early period post-operation,and while the totally administrated begin to effect, stop totallyadministrated to locally administrated until the fourteenth daypost-operation. It still need the following study whether thisproject could exert the Nimodipine effect maximum and reducethe intracranial infection. 5. It still need the following studywhether the result that Nimodipine administrated totally leadsthe MABP falling induces the CPP descending and counteractsthe effect of expanding the cerebral blood vessel.更多还原