Gelmers H J, Gorter K, de Weerdt C J, Wiezer H J
Department of Neurology, Streekziekenhuis, Almelo, the Netherlands.
N Engl J Med. 1988 Jan 28;318(4):203-7. doi: 10.1056/NEJM198801283180402.
Recent investigations suggest that increased cellular calcium concentrations may be implicated in neuronal death after ischemia. To determine whether treatment with a calcium-channel blocker would improve survival and neurologic outcome in acute ischemic stroke, we enrolled 186 patients in a prospective, double-blind, randomized, placebo-controlled trial of nimodipine (30 mg every six hours), begun within 24 hours of the onset of symptoms of an acute ischemic stroke. During the four-week treatment period, mortality from all causes was significantly reduced with nimodipine as compared with placebo (8 deaths [8.6 percent] vs. 19 [20.4 percent]). The improvement in survival was restricted to men. During the follow-up period of six months, an additional eight patients in each group died. A significantly better neurologic outcome, as assessed by the Mathew scale of neurologic deficit, was also observed in the nimodipine group. The improvement in neurologic status was greatest in patients with a moderate to severe deficit at base line. There were no important side effects except for one episode of reversible azotemia that may have been related to treatment with nimodipine. Our data suggest that patients with acute ischemic stroke may benefit from early treatment with nimodipine, but this therapeutic effect appears to be limited to men.
近期研究表明，细胞钙浓度升高可能与缺血后的神经元死亡有关。为确定钙通道阻滞剂治疗能否改善急性缺血性卒中患者的生存率及神经功能结局，我们开展了一项前瞻性、双盲、随机、安慰剂对照试验，纳入186例急性缺血性卒中症状发作24小时内开始服用尼莫地平（每6小时30毫克）的患者。在四周的治疗期内，与安慰剂相比，尼莫地平使各种原因导致的死亡率显著降低（8例死亡[8.6%]对19例[20.4%]）。生存率的改善仅限于男性。在六个月的随访期内，每组又有8例患者死亡。根据Mathew神经功能缺损量表评估，尼莫地平组的神经功能结局也显著更好。神经功能状态的改善在基线时中度至重度缺损的患者中最为明显。除了1例可能与尼莫地平治疗有关的可逆性氮质血症外，没有其他重要的副作用。我们的数据表明，急性缺血性卒中患者可能从早期尼莫地平治疗中获益，但这种治疗效果似乎仅限于男性。
