Kinoshita Y, Terada T, Nakamura Y, Nakai E, Nakai K, Itakura T, Naka Y, Naka D, Takehara R, Imai H
Department of Neurological Surgery, Wakayama Medical College.
No Shinkei Geka. 1995 Oct;23(10):881-7.
Thirty-one cases of cerebral vasospasm following subarachnoid hemorrhage were treated with intraarterial papaverine infusion. Symptomatic cases were nineteen, and asymptomatic cases were twelve. Papaverine (120 mg/saline 50 ml, 30 min) was injected superselectively to vasospastic vessels through a microcatheter. The rate of symptomatically improved cases was 63% initially, but about two thirds of those cases had recurrence within a day. The 63% of symptomatic cases showed infarction in spite of papaverine infusion. Three cases of recurrent vasospasm after intra-arterial papaverine underwent PTA and showed good dilatation of vasospastic vessels. The complications of our intra-arterial papaverine were hypotension in two cases, convulsion in one case and transient disturbed consciousness in one case. We experienced no fatal complications. Overall outcome was ADL1 (19%), ADL2 (25%), ADL3 (44%), ADL4 (0%), ADL5 (6%), and death (6%). Since the effect of intra-arterial papaverine infusion is of short duration and weak, combination of PTA and papaverine may be necessary. It is recommended to use papaverine for vasospasm in distal arteries such as M2, A1, A2, and to carry out PTA for proximal arteries such as ICA and M1.
31例蛛网膜下腔出血后发生脑血管痉挛的患者接受了动脉内罂粟碱灌注治疗。有症状的病例19例，无症状的病例12例。通过微导管将罂粟碱（120mg/50ml生理盐水，30分钟）超选择性注入痉挛血管。最初有症状改善的病例比例为63%，但其中约三分之二的病例在一天内复发。63%有症状的病例尽管进行了罂粟碱灌注仍出现梗死。3例动脉内罂粟碱治疗后复发性血管痉挛的患者接受了经皮腔内血管成形术（PTA），血管痉挛血管显示出良好的扩张。我们动脉内使用罂粟碱的并发症包括2例低血压、1例惊厥和1例短暂意识障碍。我们未出现致命并发症。总体结果为日常生活能力1级（ADL1，19%）、ADL2级（25%）、ADL3级（44%）、ADL4级（0%）、ADL5级（6%）和死亡（6%）。由于动脉内罂粟碱灌注的效果持续时间短且作用较弱，可能需要将PTA与罂粟碱联合使用。建议对M2、A1、A2等远端动脉的血管痉挛使用罂粟碱，对颈内动脉（ICA）和M1等近端动脉进行PTA。
