Tsurushima H, Kamezaki T, Nagatomo Y, Hyodo A, Nose T
Department of Neurosurgery, Ibaraki Seinam Medical Center Hospital, Japan.
Neurol Med Chir (Tokyo). 2000 Feb;40(2):112-5. doi: 10.2176/nmc.40.112.
Complications associated with intraarterial papaverine infusion occurred in two patients treated for vasospasm due to subarachnoid hemorrhage (SAH). A 42-year-old male with an anterior communicating artery aneurysm underwent craniotomy and aneurysm clipping. Five days after the SAH occurred, angiography demonstrated moderate vasospasm in spite of hypervolemic-hypertensive therapy. During papaverine infusion into the carotid artery, he suffered loss of consciousness due to a seizure for a few minutes. A 61-year-old female with a right internal carotid-posterior communicating artery aneurysm underwent clipping. Six days after the SAH occurred, angiography demonstrated severe vasospasm in spite of hypervolemic-hypertensive therapy. Angiography performed immediately after papaverine infusion into the carotid artery revealed exacerbation of the vasospasm. Finally she suffered cerebral infarction and died. Complications of intraarterial papaverine infusion are potentially dangerous. We recommend trial administration of papaverine with angiography and neurological examination before full dose infusion to avoid complications.
两名因蛛网膜下腔出血（SAH）导致血管痉挛而接受治疗的患者出现了与动脉内注入罂粟碱相关的并发症。一名患有前交通动脉瘤的42岁男性接受了开颅手术和动脉瘤夹闭术。SAH发生五天后，尽管进行了扩容-高血压治疗，血管造影仍显示中度血管痉挛。在向颈动脉注入罂粟碱的过程中，他因癫痫发作而失去意识几分钟。一名患有右侧颈内-后交通动脉瘤的61岁女性接受了夹闭术。SAH发生六天后，尽管进行了扩容-高血压治疗，血管造影仍显示严重血管痉挛。在向颈动脉注入罂粟碱后立即进行的血管造影显示血管痉挛加重。最终，她发生了脑梗死并死亡。动脉内注入罂粟碱的并发症具有潜在危险性。我们建议在全剂量注入前，先进行罂粟碱试验性给药，并结合血管造影和神经学检查，以避免并发症。
