2023 年第 3 期 第 18 卷

尼莫地平术中灌洗对颅内动脉瘤术后脑血管痉挛的影响

Effect of nimodipine intraoperative lavage on cerebral vasospasm after intracranial aneurysm surgery

作者：王素青1黄生炫2杨帆3

英文作者：Wang Suqing1 Huang Shengxuan2 Yang Fan3

单位：1中国人民武装警察部队特色医学中心神经创伤及修复研究所，天津300162；2福建医科大学附属三明第一医院神经外科，三明365000；3宝鸡高新医院神经外科，宝鸡721000

英文单位：1Institute of Nerve Trauma and Repair Characteristic Medical Center of Chinese People′s Armed Police Force Tianjin 300162 China; 2Department of Neurosurgery Affiliated Sanming First Hospital of Fujian Medical University Sanming 365000 China; 3Department of Neurosurgery Baoji High-tech Hospital Baoji 721000 China

关键词：

英文关键词：Intracranialaneurysm；Craniotomyclipping；Cerebralvasospasm；Nimodipine

• 摘要：

• 目的 探讨尼莫地平术中灌洗对颅内动脉瘤开颅夹闭术患者术后脑血管痉挛的预防效果。方法 选取中国人民武装警察部队特色医学中心2019年10月至2022年1月收治的60例颅内动脉瘤患者，按随机数字表法分为对照组和观察组，各30例。2组患者由同一组医师实施颅内动脉瘤开颅夹闭术,对照组术区以0.9%氯化钠注射液冲洗，至冲洗液清亮；观察组取注射用尼莫地平4 mg+0.9%氯化钠注射液500 ml，配置溶液对术区进行灌洗。比较2组出院时疗效，术后脑血管痉挛发生率，手术前后大脑中动脉、后动脉及椎基底动脉平均血流速度，手术前后相关实验室指标水平。结果 观察组与对照组出院时预后良好率比较［96.7%（29/30）比90.0%（27/30）］，差异无统计学意义（P=0.605）。观察组术后脑血管痉挛发生率明显低于对照组［3.3%（1/30）比23.3%（7/30）］，差异有统计学意义（P=0.023）。2组术后1周大脑中动脉、后动脉及椎基底动脉平均血流速度均低于术前，且观察组均低于对照组，差异均有统计学意义（均P＜0.05）。2组术后1周可溶性血管细胞黏附分子1 （sVCAM-1）、神经元特异性烯醇化酶（NSE）水平均低于术前，中枢神经特异性蛋白（S100β）水平均高于术前，且观察组术后1周sVCAM-1、NSE水平低于对照组，S100β水平高于对照组，差异均有统计学意义（均P＜0.05）。结论 尼莫地平术中灌洗可减少颅内动脉瘤开颅夹闭术患者术后脑血管痉挛的发生，减少大脑动脉血流速度，减轻脑组织损伤程度，改善患者预后。

• Objective  To investigate the effect of intraoperative lavage with nimodipine on the prevention of postoperative cerebral vasospasm in patients undergoing intracranial aneurysm craniotomy clamping. Methods  Sixty patients with intracranial aneurysm admitted to Characteristic Medical Center of Chinese People′s Armed Police Force from October 2019 to January 2022 were selected. They were divided into the control group and the observation group according to the random number table method, with 30 patients in each group. The control group was treated with intracranial aneurysm craniotomy clipping, and the operation area was flushed with 0.9% sodium chloride injection until the flushing solution was clear. The operation area of the observation group had lavage with 4 mg of nimodipine solution + 500 ml of 0.9% sodium chloride injection. The prognosis at discharge, incidence of postoperative cerebral vasospasm, average blood flow velocities of middle cerebral artery, posterior cerebral artery, vertebral basilar artery, and levels of relevant laboratory factors before and after operation were compared between the two groups. Results  There was no significant difference in the rate of good outcome at discharge between the observation group and the control group ［96.7%(29/30) vs 90.0%(27/30)］ (P=0.605). The incidence of postoperative cerebral vasospasm in the observation group was significantly lower than that in the control group ［3.3%(1/30) vs 23.3%(7/30)］(P=0.023). The average blood flow velocities of middle cerebral artery, posterior cerebral artery and vertebral basilar artery in both groups 1 week after surgery were lower than those before surgery, and the velocities in the observation group were lower than those in the control group (all P＜0.05). The levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) and neuron specific enolase (NSE) in both groups 1 week after surgery were lower than those before surgery, and the levels of central nervous specific protein (S100β) were higher than those before surgery; compared to the control group, the levels of sVCAM-1 and NSE were lower in the observation group 1 week after surgery, and the level of S100β was higher (all P＜0.05). Conclusion  Intraoperative lavage with nimodipine reduces the occurrence of postoperative cerebral vasospasm, decreases cerebral artery blood flow velocity and degree of brain tissue damage, and improves prognosis in patients undergoing intracranial aneurysm craniotomy clamping.