尼莫地平在动脉瘤夹闭术术中灌洗的疗效

发布时间：2018-03-23 12:53

本文选题：尼莫地平　切入点：颅内动脉瘤　出处：《安徽医科大学》2014年硕士论文

【摘要】：目的：在动脉瘤开颅显微夹闭术中，将50ml尼莫地平溶液（10mg/50ml,德国,拜耳公司）与生理盐水500ml配成1:10的溶液进行术区灌洗，探讨尼莫地平在颅内动脉瘤夹闭术术中灌洗的临床疗效方法：本课题回顾性分析2012年1月至2013年4月,我院收治经CTA或DSA确诊Hunt-Hess分级在I-III级并选择动脉瘤夹闭术的60例患者，根据术中是否应用尼莫地平灌洗将其分为两组，即灌洗组（术中应用尼莫地平灌洗）和对照组（术中未应用尼莫地平灌洗）。灌洗组30例患者，男15例，女15例，年龄33-72岁，平均（51.57±9.863）岁，前交通（或大脑前）动脉瘤12例，大脑中（或颈内）动脉瘤8例，颈内-后交通动脉瘤10例。对照组30例患者，男10例，女20例，年龄22-70岁，平均（52.6±10.660）岁，前交通（或大脑前）动脉瘤14例，大脑中（或颈内）动脉瘤6例，颈内-后交通动脉瘤10例。对两组术后第1天CT影像改变、出院时和随访时预后（改良Rankin评分表）进行比较分析。结果：灌洗组出院时预后平均评分为（1.17±1.533）分，对照组出院时预后平均评分（1.37±1.752）分， P值（0.640）大于0.05；灌洗组随访时预后平均评分为（1.10±1.423）分，对照组随访时预后平均评分（1.30±1.664）分，P值（0.619）大于0.05；灌洗组术后第一天CT影像上出现梗死灶例数为4（13.3%），对照组术后第一天CT影像上出现梗死灶例数为3（10.0%），，P值（1.000）大于0.05。灌洗组和对照组术后第1天梗死率、出院时和随访时预后平均评分差异均无统计学意义（P0.05）。结论：尼莫地平术中灌洗对患者的术后第一天梗死率、出院时和随访时预后并无改善，术中应用尼莫地平灌洗无临床价值，但还需要增加样本量或进一步设计多中心前瞻性随机对照研究，以便得到更加有说服力的结论。
[Abstract]:Objective: to study the clinical effect of nimodipine in intracranial aneurysm clipping operation by using 10 mg / 50 ml of 50ml nimodipine solution and normal saline 500ml as 1:10 solution during microclipping of aneurysm. Methods: from January 2012 to April 2013, 60 patients with Hunt-Hess grade of I-III diagnosed by CTA or DSA and selected for aneurysm clipping were retrospectively analyzed. The patients were divided into two groups according to whether Nimodipine was used in operation or not. There were 30 patients in the lavage group (15 males and 15 females, aged 33-72 years, mean 51.57 卤9.863 years), 12 patients with anterior communicating (or anterior cerebral) aneurysm. In the control group, there were 30 patients (male 10, female 20, aged 22-70 years, mean 52.6 卤10.660 years old), and 14 cases of anterior communicating (or anterior cerebral) aneurysm. There were 6 cases of middle or internal carotid aneurysms and 10 cases of internal and posterior communicating artery aneurysms. The changes of CT images on the first day after operation and the prognosis (modified Rankin scale) at discharge and follow-up were compared between the two groups. Results: the mean prognostic score at discharge was 1.17 卤1.533 in lavage group, 1.37 卤1.752 in control group (P < 0.640), and 1.10 卤1.423 in lavage group. In the control group, the mean prognostic score was 1.30 卤1.664 (P = 0.619) > 0.05, and the number of infarcted lesions on CT images on the first day after operation in the lavage group was 413.3%, and on the first day after operation in the control group, the number of infarcted foci on CT images of the control group was 3% 10.0% (P = 1.000) > 0.05.In the lavage group, the number of infarcts appeared on CT images was higher than that in the control group. And the infarct rate of the control group on the first day after operation, There was no significant difference in mean prognostic score at discharge and follow-up (P 0.05). Conclusion: Nimodipine intraoperative lavage has no effect on the rate of infarction on the first day after operation, and the prognosis at discharge and follow-up. Nimodipine is of no clinical value during operation. But there is a need to increase the sample size or to further design a multicenter prospective randomized controlled study in order to obtain a more convincing conclusion.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41

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