1Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama,Japan; and.
2Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec,Canada.
J Neurosurg. 2018 Mar;128(3):717-722. doi: 10.3171/2016.10.JNS162227. Epub 2017 Mar 3.
OBJECTIVE Delayed cerebral ischemia (DCI) is an important complication after aneurysmal subarachnoid hemorrhage (aSAH). Although intrathecal milrinone injection via lumbar catheter to prevent DCI has been previously reported to be safe and feasible, its effectiveness remains unknown. The goal of this study was to evaluate whether intrathecal milrinone injection treatment after aSAH significantly reduced the incidence of DCI. METHODS The prospectively maintained aSAH database was used to identify patients treated between January 2010 and December 2015. The cohort included 274 patients, with group assignment based on treatment with intrathecal milrinone injection or not. A propensity score model was generated for each patient group, incorporating relevant patient variables. RESULTS After propensity score matching, 99 patients treated with intrathecal milrinone injection and 99 without treatment were matched on the basis of similarities in their demographic and clinical characteristics. There were significantly fewer DCI events (4% vs 14%, p = 0.024) in patients treated with intrathecal milrinone injection compared with those treated without it. However, there were no significant differences between the 2 groups with respect to their 90-day functional outcomes (46% vs 36%, p = 0.31). The likelihood of chronic secondary hydrocephalus, meningitis, and congestive heart failure as complications of intrathecal milrinone injection therapy was also similar between the groups. CONCLUSIONS In propensity score-matched groups, the intrathecal administration of milrinone via lumbar catheter showed significant reduction of DCI following aSAH, without an associated increase in complications.
迟发性脑缺血（DCI）是蛛网膜下腔出血（aSAH）后的一种重要并发症。虽然先前有报道经腰椎导管鞘内注射米力农预防 DCI 既安全又可行，但疗效尚不清楚。本研究旨在评估 aSAH 后鞘内注射米力农治疗是否能显著降低 DCI 的发生率。
使用前瞻性维护的 aSAH 数据库来确定 2010 年 1 月至 2015 年 12 月期间接受治疗的患者。该队列包括 274 例患者，根据是否接受鞘内米力农注射进行分组。为每个患者组生成一个倾向评分模型，纳入相关的患者变量。
在进行倾向评分匹配后，根据患者的人口统计学和临床特征的相似性，99 例接受鞘内米力农注射治疗的患者与 99 例未接受治疗的患者进行了匹配。与未接受治疗的患者相比，接受鞘内米力农注射治疗的患者 DCI 事件（4%对 14%，p=0.024）明显减少。然而，两组患者 90 天的功能预后（46%对 36%，p=0.31）无显著差异。鞘内米力农注射治疗的并发症，如慢性继发性脑积水、脑膜炎和充血性心力衰竭，在两组之间的发生率也相似。
在倾向评分匹配的组中，经腰椎导管鞘内给予米力农可显著降低 aSAH 后 DCI 的发生，且不增加并发症。
