Clinical Research Internship Study Program, Mayo Clinic, Jacksonville, FL, USA.
Neurocrit Care. 2012 Jun;16(3):368-75. doi: 10.1007/s12028-011-9659-8.
Delayed cerebral arterial vasospasm is one of the leading causes of death and disability after aneurysmal subarachnoid hemorrhage (aSAH). We evaluated the safety of intraventricular nicardipine (IVN) for vasospasm (VSP) in aSAH patients, and outcomes compared with a control population.
A retrospective case-control study was conducted for aSAH patients treated with IVN at Mayo Clinic, Jacksonville, FL, from March 2009 to January 2011. Controls were matched by age, gender, and Fisher grade. Safety was evaluated by the incidence of intracranial bleeding and infection. Outcome was measured by Glasgow Outcome Scale at 30 and 90 days. IVN effects on VSP were evaluated by transcranial Doppler (TCD).
Thirteen aSAH patients and one arteriovenous malformation (AVM)-related SAH patient received IVN for VSP and were matched with 14 aSAH patients without IVN therapy for a total of 28 cases. Median dose was 4 mg (range 3-7), and median number of doses was seven (range 1-17). Mean flow velocity decreased after IVN (120.2 and 101.6 cm/s-82.0 and 72.8 cm/s, right and left middle cerebral arteries, respectively). No significant difference was seen in clinical outcomes between controls and cases at 30 days (P = 0.443) and 90 days (P = 0.153). There were no incidences of bleeding or infection with 111 nicardipine injections.
IVN appears relatively safe and effective in treating VSP by TCD, but there was no difference in clinical outcomes between nicardipine and control patients at 30 and 90 days. In the future, larger studies are needed to evaluate the clinical outcome with IVN.
迟发性颅内动脉血管痉挛是蛛网膜下腔出血（aSAH）后死亡和残疾的主要原因之一。我们评估了脑室注射硝苯地平（IVN）治疗 aSAH 患者血管痉挛（VSP）的安全性，并与对照组进行了比较。
对 2009 年 3 月至 2011 年 1 月在佛罗里达州杰克逊维尔的梅奥诊所接受 IVN 治疗的 aSAH 患者进行了回顾性病例对照研究。对照组按年龄、性别和 Fisher 分级匹配。安全性通过颅内出血和感染的发生率进行评估。结果通过格拉斯哥预后量表在 30 天和 90 天进行测量。通过经颅多普勒（TCD）评估 IVN 对 VSP 的影响。
13 例 aSAH 患者和 1 例动静脉畸形（AVM）相关的 aSAH 患者因 VSP 接受 IVN 治疗，并与 14 例未接受 IVN 治疗的 aSAH 患者相匹配，共 28 例。中位剂量为 4mg（范围 3-7），中位剂量数为 7（范围 1-17）。IVN 后平均血流速度降低（右侧和左侧大脑中动脉分别为 120.2 和 101.6cm/s-82.0 和 72.8cm/s）。30 天（P=0.443）和 90 天（P=0.153）时，对照组和病例组之间的临床结果无显著差异。111 次尼卡地平注射均无出血或感染。
TCD 显示 IVN 治疗 VSP 相对安全有效，但 30 天和 90 天时尼卡地平与对照组患者的临床结果无差异。未来需要更大规模的研究来评估 IVN 的临床结局。
