Clinical trial of nimodipine in the treatment of patients with subarachnoid hemorrhage
Objective To analyze the preventive effect and safety of intracisternal perfusion of nimodipine on delayed cerebral vasospasm(DCVS)after subarachnoid hemorrhage(SAH).Methods SAH patients treated with intracranial aneurysm clipping were divided into control group and treatment group according to cohort method.The control group was given basic treatment such as blood dilution,volume expansion and pressure boosting after operation.After DCVS was found,nimodipine injection 2.5-5.0 mL·h-1 was injected intravenously.The treatment group was given continuous perfusion of nimodipine solution(nimodipine injection:compound sodium chloride injection=1:19)for 48 h in the cerebral cistern on the basis of the control group,and the pumping speed was 20 mL·L-1.The course of treatment in both groups was 14 days.The incidence of DCVS was recorded at 3,5,7 and 14 days after operation.The neurological function[National Institutes of Health Stroke Scale(NIHSS)score],state of consciousness[Glasgow Coma Scale(GCS)score],serum DCVS mechanism indexes[platelet-derived growth factor receptor β(PDGFRβ),matrix metalloproteinase-9(MMP-9),prostacyclin I2(PGI2),fibrin degradation product(FDP)]were compared between the two groups before treatment and 14 days after treatment.The occurrence of postoperative complications such as delayed cerebral ischemia was recorded.The prognosis of the two groups was evaluated by modified Rankin scale(mRS)at 3 months after operation,and the safety was evaluated.Results In this study,39 cases were enrolled in the control group and 43 cases in the treatment group.The incidence of DCVS in the treatment group and the control group were 25.58％and 48.72％at 3 days after operation,20.93％and 43.59％at 5 days after operation,and 13.95％and 38.46％at 7 days after operation,respectively.The above indexes in the treatment group were significantly different from those in the control group(all P＜0.05).After 14 days of treatment,the NIHSS score of the treatment group and the control group were 2.08±0.43 and 2.96±0.52,respectively;the GCS score were 13.22±0.48 and 12.36±0.50,respectively;the serum PDGFRβ were(70.22±5.97)and(74.86±6.54)ng·mL-1,respectively;MMP-9 were(189.44±17.23)and(213.95±16.81)ng·mL-1,respectively;PGI2 were(96.18±5.84)and(89.44±6.27)ng·L-1;FDP were(1.62±0.50)and(2.13±0.48)mg·L-1,respectively.The above indexes in the treatment group were significantly different from those in the control group.The incidence of delayed cerebral ischemia in the treatment group was 4.65％,which was significantly lower than in the control group(23.08％,P＜0.05).Three months after operation,there were no deaths in the two groups.The mRS grades of the treatment group and the control group were(0.74±0.17)and(1.19±0.21)points,respectively;and the good prognosis rates were 97.67％and 82.05％,respectively.There were statistically significant differences in the above indicators between the treatment group and the control group(all P＜0.05).The total incidence of adverse drug reactions in the treatment group and the control group was 11.63％and 5.13％,respectively,and the difference was not statistically significant(P＞0.05).Conclusion Intracisternal nimodipine perfusion can reduce the incidence rates of DCVS and delayed cerebral ischemia after SAH,and improve the neurological function and prognosis of patients.
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