Kapapa Thomas, König Ralph, Mayer Benjamin, Braun Michael, Schmitz Bernd, Müller Silwia, Schick Julia, Wirtz Christian Rainer, Pala Andrej
Department of Neurosurgery, University Hospital Ulm, Ulm, Germany.
Department of Neurosurgery, University of Ulm, Bezirkskrankenhaus Günzburg, Günzburg, Germany.
Front Neurol. 2022 Feb 18;12:812898. doi: 10.3389/fneur.2021.812898. eCollection 2021.
To determine the frequency and severity of complications associated with the continuous intra-arterial infusion of nimodipine (CIANI) as a new treatment of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH).
Patients from two centers ( = 718) treated for SAH between 2008 and 2016 were included. Demographic and SAH-related parameters were evaluated, and also the frequency of adverse events (AEs) and complications including their severity (mild, moderate, and severe). Clinical outcome was analyzed using Glasgow Outcome Scale (GOS). The unfavorable outcome was defined as GOS 1 to 3, and favorable outcome as GOS 4 to 5. The Short-Form 36 (SF-36) health-related quality-of-life (QoL) questionnaire served as a QoL measurement.
Of 718 patients, 65 (9%) were treated by CIANI and had a higher clinical or imaging grade of bleeding severity. Clinical deterioration while on treatment happened more often in patients who were treated with CIANI than in others. In patients with CIANI, 67% had AEs and/or complications during the treatment. Nimodipine-associated hypotension was seen in 8% (mild). Catheter-associated thrombus occurred in 9% (moderate). New intracerebral hemorrhage was found in 14% (moderate). A total of 6% treated by CIANI died during the treatment period (severe). More than one-third (39%) of patients of CIANI reached at least moderate disability, and 23% showed good recovery. Patients who received CIANI showed reduced QoL, but differences in mental and general health, and also pain were minimal.
Patients who received CIANI had higher rates of AEs and complications. However, this does not exclude the possibility that the use of CIANI might be helpful in patients with severe and therapy-refractory CV and DCI. Controlled and randomized studies would be helpful to clarify this question but they are methodologically and ethically challenging.
确定作为动脉瘤性蛛网膜下腔出血（SAH）后迟发性脑缺血（DCI）新治疗方法的尼莫地平持续动脉内输注（CIANI）相关并发症的发生率和严重程度。
纳入2008年至2016年间在两个中心接受SAH治疗的患者（n = 718）。评估人口统计学和SAH相关参数，以及不良事件（AE）和并发症的发生率及其严重程度（轻度、中度和重度）。使用格拉斯哥预后量表（GOS）分析临床结局。不良结局定义为GOS 1至3，良好结局定义为GOS 4至5。简短健康调查36项（SF-36）健康相关生活质量（QoL）问卷用作QoL测量工具。
718例患者中，65例（9%）接受了CIANI治疗，且出血严重程度的临床或影像分级更高。接受CIANI治疗的患者在治疗期间临床恶化的情况比其他患者更常见。在接受CIANI治疗的患者中，67%在治疗期间出现AE和/或并发症。8%（轻度）出现尼莫地平相关低血压。9%（中度）发生导管相关血栓。14%（中度）发现新的脑出血。接受CIANI治疗的患者中共有6%在治疗期间死亡（严重）。超过三分之一（39%）接受CIANI治疗的患者至少达到中度残疾，23%显示恢复良好。接受CIANI治疗的患者QoL降低，但在心理和总体健康以及疼痛方面的差异最小。
接受CIANI治疗的患者AE和并发症发生率较高。然而，这并不排除CIANI的使用可能对严重且治疗难治性脑血管痉挛（CV）和DCI患者有帮助的可能性。对照和随机研究将有助于阐明这个问题，但在方法学和伦理学上具有挑战性。
