Stiefel Michael F, Spiotta Alejandro M, Udoetuk Joshua D, Maloney-Wilensky Eileen, Weigele John B, Hurst Robert W, LeRoux Peter D
Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, PA 19107, USA.
Neurocrit Care. 2006;4(2):113-8. doi: 10.1385/NCC:4:2:113.
Intra-arterial papaverine (IAP) is used to treat symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). IAP, however, can increase intracranial pressure (ICP). In this study we examined whether IAP alters brain oxygen (BtO2).
Poor clinical grade (Hunt & Hess IV or V) SAH patients who underwent continuous ICP and BtO2 monitoring during IAP infusion for symptomatic cerebral vasospasm were evaluated as part of a prospective observational study.
Data are available for five patients (median age 58) who received IAP for cerebral vasospasm 4 to 7 days after SAH. In each patient, angiographic vasospasm was improved on postinfusion angiogram. Mean ICP before IAP was 23.04 +/- 1.18 mmHg; it increased immediately after IAP infusion and remained elevated (29.89 +/- 1.18 mmHg; p < 0.05) during IAP and for approximately 10 minutes after IAP ended. Baseline mean arterial pressure (MAP) was 110.55 +/- 1.36 mmHg. During IAP treatment MAP remained stable (110.90 +/- 2.00 mmHg; p = 0.31). Mean BtO2 before IAP was 32.99 +/- 1.45 mmHg. There was a significant BtO2 decrease in all patients during IAP to a mean of 22.96 +/- 2.9 mmHg (p < 0.05). BtO2 returned to baseline within 10 minutes after IAP ended. There was a modest relationship between the ICP increase and BtO2 decrease (R2 = 0.526).
IAP infusion to treat cerebral vasospasm following SAH can increase ICP and reduce BtO2. The IAP-induced reduction in BtO2 may help explain why IAP, although it reverses arterial narrowing, does not improve patient outcome.
动脉内注射罂粟碱（IAP）用于治疗动脉瘤性蛛网膜下腔出血（SAH）后的症状性脑血管痉挛。然而，IAP可升高颅内压（ICP）。在本研究中，我们检测了IAP是否会改变脑氧（BtO2）。
作为一项前瞻性观察性研究的一部分，对在IAP输注治疗症状性脑血管痉挛期间接受持续ICP和BtO2监测的临床分级较差（Hunt&Hess IV或V级）的SAH患者进行评估。
有5例患者（中位年龄58岁）的数据，这些患者在SAH后4至7天接受IAP治疗脑血管痉挛。在每例患者中，输注后血管造影显示血管痉挛有所改善。IAP前平均ICP为23.04±1.18 mmHg；IAP输注后立即升高，并在IAP期间及IAP结束后约10分钟内持续升高（29.89±1.18 mmHg；p<0.05）。基线平均动脉压（MAP）为110.55±1.36 mmHg。IAP治疗期间MAP保持稳定（110.90±2.00 mmHg；p = 0.31）。IAP前平均BtO2为32.99±1.45 mmHg。所有患者在IAP期间BtO2均显著下降，平均降至22.96±2.9 mmHg（p<0.05）。IAP结束后10分钟内BtO2恢复至基线水平。ICP升高与BtO2下降之间存在适度相关性（R2 = 0.526）。
IAP输注治疗SAH后的脑血管痉挛可升高ICP并降低BtO2。IAP引起的BtO2降低可能有助于解释为什么IAP虽然能逆转动脉狭窄，但并未改善患者预后。
