Effect observation of nimodipine combined with edaravone in treatment of cerebral vasospasm after subarachnoid hemorrhage
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摘要:目的 探讨尼莫地平联合依达拉奉治疗蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)的疗效。方法 将80例SAH后CVS患者随机分为观察组与对照组，每组40例。2组均给予常规治疗，对照组应用依达拉奉静脉滴注，观察组联合尼莫地平静脉滴注。比较2组总有效率及治疗前后炎性因子水平、血清S100β蛋白、内皮素-1(ET-1)水平、大脑中动脉(MCA)血流速度、格拉斯哥昏迷评分(GCS)、美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)及不良反应。结果 观察组总有效率97.50%, 显著高于对照组的85.00%(P < 0.05); 治疗后，观察组炎性因子水平及血清S100β蛋白、ET-1水平、MCA血流速度均显著低于对照组(P < 0.05); 治疗后，观察组GCS评分、BI显著高于对照组, NIHSS评分显著低于对照组(P < 0.05); 2组不良反应发生率比较无显著差异(P>0.05)。结论 联合应用尼莫地平与依达拉奉治疗SAH后CVS疗效显著，可有效抑制炎性反应，减轻CVS严重程度。Abstract:Objective To investigate the effect of nimodipine combined with edaravone in the treatment of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH).Methods A total of 80 patients with CVS after SAH were randomly divided into observation group and control group, with 40 cases in each group. Both groups were given routine treatment, the control group was treated with edaravone by intravenous drip, while the observation group was treated with edaravone combined with nimodipine by intravenous drip. The total effective rate, levels of inflammatory factors, serum S100β protein, endothelin-1 (ET-1), blood flow velocity of middle cerebral artery (MCA), Glasgow coma score (GCS), National Institutes of Health Stroke Scale (NIHSS), Barthel index (BI) before and after treatment and adverse reactions were compared between the two groups.Results The total effective rate of the observation group was 97.50%, which was significantly higher than 85.00% of the control group (P < 0.05). After treatment, the levels of inflammatory factors, serum S100β protein, ET-1 and MCA blood flow velocity of the observation group were significantly lower than those of the control group (P < 0.05). After treatment, the GCS score and BI of the observation group were significantly higher than those of the control group, and the NIHSS score was significantly lower than that of the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion The combination of nimodipine and edaravone is effective in the treatment of CVS after SAH, which can effectively inhibit inflammatory response and reduce the severity of CVS.
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Keywords:
- nimodipine /
- edaravone /
- subarachnoid hemorrhage /
- cerebral vasospasm /
- endothelin-1 /
- middle cerebral artery
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表 1 2组临床疗效比较
组别 n 显效 有效 无效 总有效率/% 观察组 40 35 4 1 97.50* 对照组 40 25 9 6 85.00 与对照组比较, *P < 0.05。 
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表 2 2组炎性因子水平比较(x±s)
组别 时点 IL-6/(ng/L) TNF-α/(ng/L) CPR/(mg/L) 观察组(n=40) 治疗前 12.64±3.02 46.78±7.05 52.94±5.78 治疗后 8.08±2.27*# 35.72±6.34*# 23.98±4.45*# 对照组(n=40) 治疗前 12.78±2.78 47.25±8.34 53.46±7.56 治疗后 9.86±2.40* 40.74±7.52* 40.72±5.46* IL-6: 白介素细胞-6; TNF-α: 肿瘤坏死因子-α; CRP: C反应蛋白。与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 3 2组血清S100β蛋白、ET-1水平及MCA血流速度比较(x±s)
组别 时点 S100β蛋白/(μg/L) ET-1/(pg/mL) MCA血流速度/(cm/s) 观察组(n=40) 治疗前 0.26±0.08 88.15±12.28 104.25±25.30 治疗后 0.15±0.05*# 70.24±8.45*# 78.85±18.25*# 对照组(n=40) 治疗前 0.27±0.06 87.56±11.55 102.68±26.32 治疗后 0.19±0.05* 74.85±8.26* 90.42±20.92* ET-1: 内皮素-1; MCA: 大脑中动脉。与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 4 2组GCS评分、NIHSS评分及BI比较(x±s)
分 组别 时点 GCS评分 NIHSS评分 BI 观察组(n=40) 治疗前 13.28±1.72 16.48±3.31 50.21±7.71 治疗后 14.76±0.98*# 7.24±2.68*# 82.19±10.11*# 对照组(n=40) 治疗前 13.07±1.65 16.13±4.15 50.93±7.89 治疗后 14.24±0.92* 8.84±2.21* 70.15±9.41* GCS: 格拉斯哥昏迷量表; NIHSS: 美国国立卫生研究院卒中量表; BI: Barthel指数。 与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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