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目的观察尼莫地平联合前列地尔治疗创伤性蛛网膜下腔出血(SAH)的临床疗效。方法选取2015年6月—2017年1月黄冈市英山县人民医院收治的创伤性SAH患者120例,根据治疗方法分为对照组和观察组,每组60例。在常规治疗基础上,对照组患者采用前列地尔注射液治疗,观察组患者采用尼莫地平联合前列地尔注射液治疗;两组患者均连续治疗2周。比较两组患者治疗前后格拉斯哥昏迷量表(GCS)评分、大脑中动脉(MCA)平均血流速度,症状缓解率,临床治疗有效率,治疗期间并发症及不良反应发生情况。结果治疗前两组患者GCS评分、MCA平均血流速度比较,差异无统计学意义(P>0.05);治疗后观察组患者GCS评分高于对照组,MCA平均血流速度低于对照组(P<0.05)。两组患者呕吐缓解率比较,差异无统计学意义(P>0.05);观察组患者头痛缓解率、脑膜刺激征缓解率及临床治疗有效率高于对照组(P<0.05)。治疗期间观察组患者脑血管痉挛、脑梗死发生率低于对照组(P<0.05),而两组患者病死率比较,差异无统计学意义(P>0.05)。治疗期间两组患者血压下降、颅腔积液、消化道出血发生率比较,差异无统计学意义异(P>0.05)。结论尼莫地平联合前列地尔治疗创伤性SAH的临床疗效确切,可有效改善患者神经功能及临床症状,减少脑血管痉挛、脑梗死的发生。
Objective To observe the clinical efficacy of nimodipine and alprostadil in the treatment of traumatic subarachnoid hemorrhage (SAH). Methods 120 patients with traumatic SAH admitted from June 2015 to January 2017 in Yingshan County People’s Hospital of Huanggang City were selected and divided into control group and observation group according to the treatment method, with 60 cases in each group. On the basis of conventional treatment, patients in the control group were treated with alprostadil injection, and patients in the observation group were treated with nimodipine and alprostadil. The patients in both groups were treated continuously for 2 weeks. The scores of Glasgow Coma Scale (GCS), average blood flow velocity of middle cerebral artery (MCA), symptom relief rate, effective rate of clinical treatment, complications during treatment and incidence of adverse reactions were compared between the two groups before and after treatment. Results There was no significant difference in GCS score and MCA average blood flow velocity between the two groups before treatment (P> 0.05). After treatment, the GCS score of observation group was higher than that of control group, and the mean blood flow velocity of MCA was lower than that of control group <0.05). There was no significant difference in emesis response rate between the two groups (P> 0.05). The relief rate of headache, the response rate of meningeal irritation and the effective rate of clinical treatment in the observation group were higher than those in the control group (P <0.05). The incidence of cerebral vasospasm and cerebral infarction in the observation group was lower than that in the control group during the treatment period (P <0.05). There was no significant difference in mortality between the two groups (P> 0.05). There was no significant difference in the incidence of blood pressure, cranial cavity effusion and gastrointestinal bleeding between the two groups during treatment (P> 0.05). Conclusion Nimodipine combined with alprostadil is effective in the treatment of traumatic SAH. It can effectively improve the neurological function and clinical symptoms, reduce the occurrence of cerebral vasospasm and cerebral infarction.