Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.
J Pharm Pharm Sci. 2020;23(1):100-108. doi: 10.18433/jpps30960.
Delayed cerebral ischemia (DCI) and vasospasm are the main challenges contributing to unfavorable outcomes following aneurysmal subarachnoid hemorrhage. Nimodipine has been shown to decrease the incidence of delayed cerebral ischemia and improve outcomes. In patients who are unable to swallow, nimodipine tablets are crushed and administered through enteral feeding tubes. However, it is not clear whether this may result in reduced clinical effectiveness. The aims of the study were to investigate the impact of nimodipine administration through enteral feeding tubes, in the first 7 days and over the 21-days period on patient outcomes.
A retrospective chart review of subarachnoid hemorrhage patients admitted at the University of Alberta Hospital, Edmonton, Alberta, Canada was carried out. Logistic regression modelling was utilized to identify predictors of vasospasm and delayed cerebral ischemia. Main outcome measures were angiographic evidence of moderate to severe vasospasm, development of delayed cerebral ischemia and hospital mortality.
85 patients were included. Following adjustment for disease severity, nimodipine administration technique was associated with vasospasm in the first 7 days of patient admission where patients receiving nimodipine via enteral feeding tubes had increased odds of vasospasm compared to those administered it as whole tablets (OR 8.9, 95% CI 1.1-73.1, p value 0.042). When analyzed over the 21-day period, nimodipine administration by feeding tube was associated with increased odds of DCI compared to whole tablets (OR 38.1, 95% CI 1.4-1067.9, p value 0.032).
Our findings suggest that nimodipine administration via enteral feeding tubes may be associated with vasospasm and DCI in subarachnoid hemorrhage patients secondary to reduced exposure. Prospective studies are needed to confirm such association and alternate methods of administration should be explored to ensure patients are getting the benefits of nimodipine.
迟发性脑缺血（DCI）和血管痉挛是导致蛛网膜下腔出血后预后不良的主要挑战。尼莫地平已被证明可降低迟发性脑缺血的发生率并改善预后。对于无法吞咽的患者，将尼莫地平片剂压碎并通过肠内喂养管给药。然而，目前尚不清楚这是否会导致临床疗效降低。本研究旨在探讨在第 1 天至第 7 天和第 21 天期间通过肠内喂养管给予尼莫地平对患者结局的影响。
对加拿大阿尔伯塔省埃德蒙顿大学医院收治的蛛网膜下腔出血患者进行回顾性图表审查。利用逻辑回归模型来确定血管痉挛和迟发性脑缺血的预测因素。主要结局指标是中度至重度血管痉挛的血管造影证据、迟发性脑缺血的发生和医院死亡率。
共纳入 85 例患者。在校正疾病严重程度后，尼莫地平的给药方式与患者入院后第 7 天内的血管痉挛有关，与给予整片尼莫地平的患者相比，通过肠内喂养管给予尼莫地平的患者发生血管痉挛的几率更高（比值比 8.9，95%置信区间 1.1-73.1，p 值 0.042）。当分析 21 天期间时，与整片尼莫地平相比，通过喂养管给予尼莫地平与 DCI 的几率增加有关（比值比 38.1，95%置信区间 1.4-1067.9，p 值 0.032）。
我们的研究结果表明，通过肠内喂养管给予尼莫地平可能与蛛网膜下腔出血患者的血管痉挛和 DCI 有关，原因是暴露减少。需要进行前瞻性研究来证实这种关联，并应探索其他给药方法，以确保患者能够从尼莫地平中获益。
