超选择性动脉内灌注维拉帕米治疗蛛网膜下腔出血后脑血管痉挛的疗效分析

发布时间：2019-02-15 20:34

【摘要】：目的探讨超选择性动脉内灌注维拉帕米治疗动脉瘤性蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)的疗效。方法回顾性分析2013年1月至2016年2月对颅内动脉瘤开颅夹闭(8例)或血管内治疗(7例)后出现CVS 15例SAH患者的临床资料,对15例患者均进行全脑DSA,使用微导管超选择至痉挛的动脉并灌注维拉帕米(11.1±3.4)mg,对照治疗前后全脑DSA表现,搜集治疗过程中血压、心率,记录灌注前后经颅多普勒超声结果,随访6个月并进行格拉斯哥预后评分(GOS)。结果 (1)对15例患者共实施了20支动脉内的灌注治疗,灌注前后比较,DSA上CVS改善14例,无明显变化1例。(2)经颅多普勒超声检查大脑中动脉的平均脑血流速度(mBFV),由超选择灌注术治疗前的(181±4)cm/s降至治疗后1 h内的(126±4)cm/s,差异有统计学意义(t=42.46,P0.01),无一例发生使用微导管所导致的并发症。(3)灌注过程中监测患者右上臂血压,灌注开始时收缩压为(138±8)mmHg,灌注结束时为(135±10)mmHg,术后1 h为(137±7)mmHg;手术开始时心率为(83±6)次/min,手术结束时为(79±8)次/min,至术后1 h为(80±5)次/min,差异均无统计学意义(P0.05)。(4)对所有患者随访6个月,6个月时的GOS评分:恢复良好9例,中度病残但能生活自理3例,重度病残生活不能自理3例。无一例植物生存或死亡。结论超选择性动脉内灌注维拉帕米,能有效改善动脉瘤性SAH造成的CVS,同时对心率及血压无明显影响。
[Abstract]:Objective to investigate the effect of superselective intraarterial infusion of verapamil in the treatment of cerebral vasospasm (CVS) after aneurysm subarachnoid hemorrhage (SAH). Methods the clinical data of 15 patients with CVS after intracranial aneurysm clipping (8 cases) or endovascular therapy (7 cases) from January 2013 to February 2016 were retrospectively analyzed. All 15 patients were treated with whole brain DSA,. The microcatheter was used to select the spastic artery and perfuse verapamil (11.1 卤3.4) mg, before and after treatment. The whole brain DSA manifestations were collected, blood pressure and heart rate were collected, and transcranial Doppler ultrasound results were recorded before and after perfusion. Follow up for 6 months and perform Glasgow prognosis score (GOS). Results (1) 15 patients were treated with 20 artery perfusion. CVS on DSA was improved in 14 patients before and after perfusion. (2) the mean cerebral blood flow velocity (mBFV),) of the middle cerebral artery was decreased from (181 卤4) cm/s before superselective perfusion to (126 卤4) cm/s, within 1 hour after treatment by transcranial Doppler ultrasound. The difference was statistically significant (t = 42.46 vs P0.01), and no complication caused by the use of microcatheter was found. (3) the blood pressure of the right upper arm was monitored during perfusion, and the systolic blood pressure was (138 卤8) mmHg, at the beginning of perfusion. 1 hour after (135 卤10) mmHg, (137 卤7) mmHg; at the end of perfusion Heart rate at the beginning of the operation was (83 卤6) / (79 卤8) times / min, at the end of min, operation, and there was no significant difference between (80 卤5) times / min, at 1 h after operation (P0.05). (4). All patients were followed up for 6 months. GOS score at 6 months: 9 cases recovered well, 3 cases were moderately disabled but able to take care of themselves, 3 cases were not able to take care of themselves. None of the plants survived or died. Conclusion superselective intraarterial infusion of verapamil can effectively improve CVS, caused by aneurysm SAH and has no effect on heart rate and blood pressure.
【作者单位】：东南大学医学院附属江阴医院神经外科;
【分类号】：R743.35

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