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蛛网膜下腔出血所致血管痉挛患者动脉内注射尼莫地平的血管造影特征及临床结局

Angiographic features and clinical outcomes of intra-arterial nimodipine injection in patients with subarachnoid hemorrhage-induced vasospasm.

作者信息

Kim Sang-Shin, Park Dong-Hyuk, Lim Dong-Jun, Kang Shin-Hyuk, Cho Tai-Hyoung, Chung Yong-Gu

机构信息

Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea.

出版信息

J Korean Neurosurg Soc. 2012 Sep;52(3):172-8. doi: 10.3340/jkns.2012.52.3.172. Epub 2012 Sep 30.

DOI:10.3340/jkns.2012.52.3.172
PMID:23115657
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3483315/
Abstract

OBJECTIVE

The aim of this study was to determine the role of intra-arterial (IA) nimodipine injections for cerebral vasospasm secondary to ruptured subarachnoid hemorrhage (SAH) and to investigate the factors that influence vasodilation and clinical outcomes.

METHODS

We enrolled 29 patients who underwent aneurysm clipping for ruptured cerebral aneurysms between 2009 and 2011, and who received IA nimodipine after subsequently presenting with symptomatic vasospasm. The degree of vasodilation shown in angiography was measured, and the correlation between the degree of vasodilation and both the interval from SAH to cerebral vasospasm and the interval from clipping to cerebral vasospasm was determined. The change in blood flow rate after IA injection was assessed by transcranial Doppler ultrasound. Multiple clinical parameters were completed before and after IA nimodipine injection to evaluate any improvements in clinical symptoms.

RESULTS

For eight patients, Glasgow Coma Scale (GCS) scores increased by two or more points. The regression analysis demonstrated a positive correlation between the change in GCS scores after IA nimodipine injection and the change in blood vessel diameter (p=0.025). A positive correlation was also observed between the interval from SAH to vasospasm and the change in diameter (p=0.040); and the interval from clipping to vasospasm and the change in diameter (p=0.022).

CONCLUSION

IA nimodipine injection for SAH-induced vasospasm led to significant vasodilation in angiography and improvement in clinical symptoms without significant complications. Our findings suggest that IA nimodipine injection should be utilized when intractable vasospasm develops despite rigorous conservative management.

摘要

目的

本研究旨在确定动脉内注射尼莫地平对蛛网膜下腔出血（SAH）破裂后继发脑血管痉挛的作用，并研究影响血管舒张和临床结局的因素。

方法

我们纳入了29例在2009年至2011年间因破裂性脑动脉瘤接受动脉瘤夹闭术，且在随后出现症状性血管痉挛后接受动脉内注射尼莫地平的患者。测量血管造影显示的血管舒张程度，并确定血管舒张程度与SAH至脑血管痉挛的间隔时间以及夹闭至脑血管痉挛的间隔时间之间的相关性。通过经颅多普勒超声评估动脉内注射后血流速度的变化。在动脉内注射尼莫地平前后完成多项临床参数评估，以评估临床症状的任何改善情况。

结果

8例患者的格拉斯哥昏迷量表（GCS）评分提高了2分或更多。回归分析表明，动脉内注射尼莫地平后GCS评分的变化与血管直径的变化呈正相关（p = 0.025）。SAH至血管痉挛的间隔时间与直径变化之间也观察到正相关（p = 0.040）；夹闭至血管痉挛的间隔时间与直径变化之间也呈正相关（p = 0.022）。

结论

动脉内注射尼莫地平治疗SAH引起的血管痉挛可导致血管造影显示明显的血管舒张，并改善临床症状，且无明显并发症。我们的研究结果表明，尽管进行了严格的保守治疗，但当出现难治性血管痉挛时，应使用动脉内注射尼莫地平。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdc2/3483315/3660d84521d3/jkns-52-172-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdc2/3483315/452f7f449bcd/jkns-52-172-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdc2/3483315/d05c12d39192/jkns-52-172-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdc2/3483315/58463e72cdc9/jkns-52-172-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdc2/3483315/903c121c20b1/jkns-52-172-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdc2/3483315/3660d84521d3/jkns-52-172-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdc2/3483315/452f7f449bcd/jkns-52-172-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdc2/3483315/d05c12d39192/jkns-52-172-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdc2/3483315/58463e72cdc9/jkns-52-172-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdc2/3483315/903c121c20b1/jkns-52-172-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdc2/3483315/3660d84521d3/jkns-52-172-g005.jpg

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