鹽酸法舒地爾聯合馬來酸桂哌齊特治療動脈瘤性蛛網膜下腔出血術后腦血管痙攣的效果

羅孝全 唐輝 李承科 陳兵 邵川

[摘要] 目的 評價馬鹽酸法舒地爾注射液聯合來酸桂哌齊特注射液治療動脈瘤性蛛網膜下腔出血術后腦血管痙攣的效果，為臨床治療提供依據。 方法 選取南充市中心醫院神經外科2016年1月～2017年3月共收治的動脈瘤性蛛網膜下腔出血術后發生腦血管痙攣患者72例，采用隨機數字表法分為對照組和觀察組各36例。對照組給予鹽酸法舒地爾注射液治療，觀察組給予鹽酸法舒地爾注射液聯合馬來酸桂哌齊特注射液治療，比較兩組治療前后白細胞介素6（IL-6）水平、CT評分、格拉斯哥預后（GOS）評分、臨床療效、不良反應情況。 結果 兩組IL-6水平在治療后均明顯降低，觀察組下降更明顯，差異有統計學意義（P < 0.01）；對照組與觀察組的CT評分與GOS評分均呈負相關（r=-0.635、0.741，P < 0.05）；總有效率上觀察組（91.67%）高于對照組（72.22%），差異有統計學意義（P < 0.05）；兩組不良反應發生率相當，差異無統計學意義（P > 0.05）。 結論 鹽酸法舒地爾聯合馬來酸桂哌齊特能有效防治動脈瘤性蛛網膜下腔出血術后腦血管痙攣，抑制炎癥因子，不良反應少，安全性好。

[關鍵詞] 腦血管痙攣；動脈瘤性蛛網膜下腔出血；馬來酸桂哌齊特；鹽酸法舒地爾

[中圖分類號] R743.35 [文獻標識碼] A [文章編號] 1673-7210（2018）03（b）-0076-04

Effect of Fasudil Hydrochloride combined with Cinepazide Maleate in the treatment of cerebral vasospasm after aneurismal subarachnoid hemorrhage

LUO Xiaoquan TANG Hui LI Chengke CHEN Bing SHAO Chuan

Department of Neurosurgery， Nanchong Central Hospital， Sichuan Province， Nanchong 637000， China

[Abstract] Objective To evaluate the effect of Fasudil Hydrochloride combined with Cinepazide Maleate in the treatment of cerebral vasospasm（CVS） after aneurismal subarachnoid hemorrhage（aSAH）， and to provide evidences for clinical treatment. Methods Seventy-two patients with CVS after aSAH were selected in the Nanchong Central Hospital from January 2016 to March 2017， and divided into control group and observation group by random number table method， with 36 cases in each group. The control group was treated with Fasudil Hydrochloride， and the observation group was treated with Cinepazide Maleate combined with Fasudil Hydrochloride， the levels of IL-6 before and after treatment， CT score， GOS Score， clinical efficacy， adverse events were compared between two groups. Results The levels of IL-6 were decreased significantly after treatment in two groups， and the observation group was significantly lower than the control group， with statistical significance （P < 0.01）. The CT score was negatively correlated with GOS score in the control group and observation group（r=-0.635， -0.741， P < 0.05）. The total effective rate of observation group（91.67%） was higher than that of control group （72.22%）， with statistical significance （P < 0.05）. The incidence of adverse events was similar between two groups， with no statistical significance （P > 0.05）. Conclusion Fasudil Hydrochloride combined with Cinepazide Maleate has significant therapeutic efficacy on CVS after aSAH， and can effectively inhibit inflammatory factors and reduce adverse events with good safety.

[Key words] Cerebral vasospasm； Aneurysmal subarachnoid hemorrhage； Cinepazide Maleate； Fasudil Hydrochloride

自發性蛛網膜下腔出血（spontaneous subarachnoid hemorrhage，SAH）的主要病因為顱內動脈瘤破裂出血，可引起患者劇烈頭痛、惡心嘔吐、意識障礙、肢體癱瘓等一系列臨床表現。SAH患者常發生腦血管痙攣（cerebral vasospasm，CVS）、腦積水、腦梗死等并發癥，導致患者預后極差，甚至危及患者生命安全。CVS是諸多并發癥中最常見、最嚴重的并發癥，常導致高致殘、致死率。因此，如何有效防治SAH后CVS一直是臨床醫生的重點研究方向，臨床上研究顯示尼莫地平注射液、尼卡地平注射液、鹽酸法舒地爾注射液、馬來酸桂哌齊特注射液對于改善CVS有一定效果，但均存在不同程度不良反應，尤其對重癥CVS療效不理想?！?br>