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目的探讨前列地尔联合尼莫地平在预防动脉瘤性蛛网膜下腔出血后症状性脑血管痉挛发生中的疗效。方法将我科收治的80例Hunt-Hess分级≤Ⅲ级的动脉瘤性蛛网膜下腔出血病例随机分为对照组与治疗组。所有病例入院后早期、足量地给予尼莫地平微泵维持治疗,并在72 h内行手术治疗(夹闭或栓塞)和腰大池引流。术后对照组继续单用尼莫地平,而治疗组加用前列地尔静滴。2组疗程均为14 d。对比2组各临床相关因素及症状性脑血管痉挛发生率。对症状性脑血管痉挛患者行320排CT灌注成像,并测量脑血流量。结果 2组的相关因素除改良Fisher分级及手术方式存在统计学差异外其余均存在可比性。治疗组有4例发生症状性脑血管痉挛,而对照组有11例,治疗组的发生率显著低于对照组。结论对动脉瘤性蛛网膜下腔出血的病例,术后给予前列地尔联合尼莫地平治疗,在预防症状性脑血管痉挛发生上的疗效显著优于单用尼莫地平,值得推广。
Objective To investigate the curative effect of alprostadil combined with nimodipine on the prevention of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Methods A total of 80 cases of aneurysmal subarachnoid hemorrhage with Hunt-Hess grade ≤Ⅲ were randomly divided into control group and treatment group. All cases were given enough nimodipine micropumps to maintain therapy early after admission, and underwent surgical treatment (clipping or embolization) and lumbar drainage within 72 hours. Control group continued nimodipine alone, while the treatment group with alprostadil intravenous infusion. The two courses of treatment were 14 d. Comparing two groups of clinically relevant factors and the incidence of symptomatic cerebral vasospasm. Patients with symptomatic cerebral vasospasm were subjected to 320-row CT perfusion imaging and cerebral blood flow was measured. Results There was comparability among the two groups except for the improvement of Fisher grade and operation method. Symptomatic cerebral vasospasm occurred in 4 patients in the treatment group, compared with 11 in the control group, which was significantly lower in the treatment group than in the control group. Conclusions The treatment of aneurysmal subarachnoid hemorrhage after the administration of alprostadil combined with nimodipine is superior to nimodipine alone in the prevention of symptomatic cerebral vasospasm and is worth promoting.