Seo Mina, Aiyagari Venkatesh, Moreno Jorge, Olson DaiWai M, Bashir Moez M I, Tenii Josephine
Mina Seo, PharmD, MBA, PGY2 Pharmacy Resident - Moffitt Cancer Center, Tampa, FL.
Venkatesh Aiyagari, MBBS, DM, UT Southwestern Medical Center, Neurological Surgery and Neurology, Dallas, TX.
J Neurosci Nurs. 2025 Aug 25. doi: 10.1097/JNN.0000000000000846.
Guidelines recommend the use of enteral nimodipine for 21 days after aneurysmal subarachnoid hemorrhage (aSAH). The recommended duration (21 d) and frequency of administration (every 4 h) may lead to noncompliance. Nurses play a critical role in medication administration, monitoring adverse reactions, and ensuring patient compliance with prescribed regimens. The aim of this study is to assess the degree of compliance with nimodipine use, causes of noncompliance and explore if adherence to nimodipine in clinical practice correlates with improved neurological outcomes as indicated by modified Rankin Scale (mRS) scores.
A retrospective study of consecutive aSAH admissions to a comprehensive stroke center over a 67-month period. Compliance was defined as receiving at least 80% of the recommended doses of nimodipine over 21 days. A chart review was performed to explore the reasons for noncompliance. We examined hospital disposition at discharge and 90-day mRS, adjusted for severity of aSAH. Compliance rates before and after a pharmacist-guided intervention were also examined.
Among 141 patients, the overall compliance rate was just 30%. The leading reasons for missed doses included hypotension (68.1%) and patients being off the unit (56%). Compliance was not associated with improvement in 90-day mRS scores for low-grade aSAH (P=0.3638) and high-grade aSAH (P=0.227). After pharmacist-guided intervention, compliance improved from 18.2% to 43.8%.
There is a high rate of noncompliance with nimodipine use in aSAH, but it did not significantly impact patient outcomes. Although pharmacist interventions improved compliance, full compliance remains challenging.
指南建议在动脉瘤性蛛网膜下腔出血（aSAH）后使用肠内尼莫地平21天。推荐的疗程（21天）和给药频率（每4小时一次）可能导致不依从。护士在给药、监测不良反应以及确保患者遵守规定治疗方案方面起着关键作用。本研究的目的是评估尼莫地平使用的依从程度、不依从的原因，并探讨临床实践中尼莫地平的依从性是否与改良Rankin量表（mRS）评分所表明的神经功能改善相关。
对一家综合卒中中心67个月期间连续收治的aSAH患者进行回顾性研究。依从性定义为在21天内接受至少80%推荐剂量的尼莫地平。进行病历审查以探究不依从的原因。我们检查了出院时的医院处置情况和90天mRS评分，并根据aSAH的严重程度进行了调整。还检查了药师指导干预前后的依从率。
在141例患者中，总体依从率仅为30%。漏服药物的主要原因包括低血压（68.1%）和患者离开病房（56%）。对于低级别aSAH（P = 0.3638）和高级别aSAH（P = 0.227），依从性与90天mRS评分的改善无关。在药师指导干预后，依从性从18.2%提高到了43.8%。
aSAH患者使用尼莫地平的不依从率很高，但并未对患者预后产生显著影响。尽管药师干预提高了依从性，但完全依从仍然具有挑战性。
