Yoshimura S, Tsukahara T, Hashimoto N, Kazekawa K, Kobayashi A
Department of Neurosurgery, National Cardiovascular Centre, Osaka, Japan.
Acta Neurochir (Wien). 1995;135(3-4):186-90. doi: 10.1007/BF02187766.
The clinical effect of combination therapy with high doses of intravenous nicardipine and intra-arterial infusion of papaverine on symptomatic vasospasm after subarachnoid haemorrhage (SAH) was analysed retrospectively. In 66 of 122 patients who underwent early aneurysm surgery between 1990 and 1993, the intracranial haemodynamics were documented by transcranial Doppler (TCD) ultrasonography. 33 of these 66 patients received high dose nicardipine intravenously (Group I); the other 33 patients were not treated with calcium antagonists (Group II). Symptomatic vasospasm occurred in 6 Group I patients (18%) and in 13 (39%) in Group II patients. All 19 symptomatic patients received an intra-arterial infusion of papaverine; 15 patients (79%) responded well to this therapy and the symptoms were reversed quickly. Although the mean flow velocity (MFV) was not different between the two groups, it was reduced significantly after papverine infusion. Our retrospective analysis suggests that symptomatic vasospasm can be treated effectively with the combination of intravenous high dose nicardipine and intra-arterial infusion of papaverine, and that the correct timing of the infusions is crucial.
回顾性分析大剂量静脉注射尼卡地平联合动脉内注射罂粟碱治疗蛛网膜下腔出血（SAH）后症状性血管痉挛的临床效果。在1990年至1993年间接受早期动脉瘤手术的122例患者中，66例通过经颅多普勒（TCD）超声记录颅内血流动力学。这66例患者中，33例接受大剂量静脉注射尼卡地平（第一组）；另外33例未接受钙拮抗剂治疗（第二组）。第一组6例患者（18%）出现症状性血管痉挛，第二组13例患者（39%）出现症状性血管痉挛。所有19例有症状的患者均接受了动脉内注射罂粟碱治疗；15例患者（79%）对该治疗反应良好，症状迅速缓解。虽然两组的平均血流速度（MFV）无差异，但罂粟碱注射后MFV显著降低。我们的回顾性分析表明，大剂量静脉注射尼卡地平联合动脉内注射罂粟碱可有效治疗症状性血管痉挛，且注射的正确时机至关重要。
