脑室内注射硝普钠防治动脉瘤性蛛网膜下腔出血术后脑血管痉挛的疗效分析

目的研究脑室内注射硝普钠防治动脉瘤性蛛网膜下腔出血后脑血管痉挛的疗效及安全性。方法将313例动脉瘤性蛛网膜下腔出血病人随机分为硝普钠治疗组（105例）和常规治疗组（208例）。均在出血后3 d内行动脉瘤夹闭术,硝普钠治疗组术后予常规治疗和脑室内注入硝普钠,而常规治疗组则仅予常规治疗。结果与常规治疗组比较,术后1-7 d硝普钠治疗组病人大脑中动脉流速均显著降低（P〈0.05）。硝普钠治疗组发生迟发性脑血管痉挛（DCVS）14例（13.3%）,继发性脑梗死7例（6.7%）;常规治疗组发生DCVS 45例（21.6%）,继发性脑梗死34例（16.3%）;两组DCVS和继发性脑梗死发生率差异均有统计学意义（P〈0.05）。两组预后差异显著（P〈0.05）,而并发症发生率差异无统计学意义（P〉0.05）。结论脑室内注入硝普钠能显著改善蛛网膜下腔出血后脑血管血流动力学变化,副作用小,是一种治疗DCVS安全、有效的新疗法。

Efficacy analysis of sodium nitroprusside intraventricular injection in treating cerebral vasospasm after the surgery for aneurysmal subarachnoid hemorrhage

Objective To research the therapeutic efficacy and safety of intraventricular injection of sodium nitroprusside （SNP） for treating cerebral vasospasm after aneurysmal subarachnoid hemorrhage （aSAH）. Methods Three hundred and thirteen patients with aSAH were randomly divided into SNP group （n = 105） and control group （n = 208）. Aneurysm clipping was performed 3 d after hemorrhage in all the patients, and then the routine treatment and SNP intraventricular injection were conducted in SNP group, while routine treatment alone was carried out in controlgroup. Results Compared with control group, the blood flow velocity of the middle cerebral artery decreased obviously 1 to 7 d after surgery in SNP group （P 〈 0.05）. Delayed cerebral vasospasm （DCVS） occurred in 14 patients （13.3%） and secondary cerebral infarction in 7 （6.7%） in SNP group, while DCVS occurred in 45 patients （21.6%） and secondary cerebral infarction in 34 （16.3%） in control group. There were statistical significances in differences of incidence rate of DCVS and secondary cerebral infarction between the two groups （P 〈 0.05）. A significant difference was found in prognosis （P 〈 0.05）, but no significant difference in complication rate between the two groups （P 〉 0.05）. Conclusion Intraventricular SNP injection can significantly improve the changes of cerebral hemodynamics after SAH, and a safe and effective therapeutic means with little side effect.