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目的探讨动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)后迟发性脑血管痉挛(delayed cerebrovascular spasm,DCVS)综合防治的临床疗效。方法96例aSAH患者随机分成两组,对照组(n=48):常规治疗加尼莫地平1~2mg/h持续泵入14d。治疗组(n=48):在对照组治疗基础上同时应用(1)甲基强的松龙30mg/kg体重静点,1次/d,连用7d。(2)盐酸法舒地尔30mg入液静点,3次/d,连用14d。(3)依达拉奉30mg入液静点,2次/d,连用14d。(4)腰穿或脑室穿刺放血性脑脊液。两组均持续监测生命体征,比较治疗前后两组临床表现,意识变化以GCS、病情以Hunt&Hess分级、预后以格拉斯哥(GOS)评分、CT、MRI、TCD结果为评价指标。结果(1)总体病情GCS、Hunt&Hess分级及Fisher分级治疗前两组无明显差异(P>0.05)。(2)头部CT或MRI:治疗组出现脑梗死灶10例(10.4%)低于对照组21例(43.8%)(P<0.05)。(3)TCD:出血后1d大脑中动脉(MCA)平均流速(单位:cm/s)对照组为115.8±11.5,治疗组为112.5±12.1,两组比较无差异(P>0.05)。治疗后3、7、14d对照组分别为158.9±13.6,199.4±17.2,129.5±14.4;治疗组130.7±11.8,140.1±16.4,116.7±13.9,在7d治疗组血流速度比对照组明显下降(P<0.05);(4)疗效:治疗组显效率(75.0%)明显高于对照组(52.1%)(P<0.05)。结论SAH后迟发性脑血管痉挛的综合防治效果更佳。
Objective To investigate the clinical efficacy of delayed cerebrospinal spasm (DCVS) in the prevention and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods 96 patients with aSAH were randomly divided into two groups, the control group (n = 48): routine treatment of nimodipine 1 ~ 2mg / h continuous pump 14d. Treatment group (n = 48): On the basis of the treatment of the control group, both (1) methylprednisolone 30mg / kg body weight intravenous injection once a day for 7 days. (2) fasudil hydrochloride 30mg into the liquid static point, 3 times / d, once every 14d. (3) Edaravone 30mg into the liquid point, 2 times / d, once every 14d. (4) lumbar puncture or ventricular puncture bleeding cerebrospinal fluid. The vital signs were monitored continuously in both groups. The clinical manifestations of both groups were compared before and after treatment. The changes of consciousness were evaluated by GCS. The patients were graded by Hunt & Hess. The prognosis was evaluated by GOS score, CT, MRI and TCD. Results (1) There was no significant difference in GCS, Hunt & Hess grade and Fisher grade between the two groups (P> 0.05). (2) Head CT or MRI: 10 cases (10.4%) of cerebral infarction in treatment group were lower than 21 cases (43.8%) of control group (P <0.05). (3) TCD: The average velocity of middle cerebral artery (MCA) at 1 day after hemorrhage (unit: cm / s) was 115.8 ± 11.5 in the control group and 112.5 ± 12.1 in the treatment group. There was no difference between the two groups (P> 0.05). At 3,7 and 14 days after treatment, the control groups were 158.9 ± 13.6 and 199.4 ± 17.2 and 129.5 ± 14.4, respectively. The treatment groups were 130.7 ± 11.8 and 140.1 ± 16.4 and 116.7 ± 13.9, respectively. The blood flow velocity in the 7-day treatment group was significantly lower than that in the control group P <0.05). (4) Efficacy: The effective rate of the treatment group (75.0%) was significantly higher than that of the control group (52.1%) (P <0.05). Conclusion The comprehensive prevention and treatment of delayed cerebral vasospasm after SAH is better.