CAJ | 학술논문

目的：探讨动脉内超选滴注法舒地尔结合常规抗血管痉挛法治疗症状性脑血管痉挛（SCVS）即时临床效果。方法回顾性分析2010年5月至2014年2月动脉瘤性蛛网膜下腔出血患者21例（FisherⅡ级2例、Ⅲ级16例、Ⅳ级3例）。全脑血管DSA造影确诊颅内动脉瘤并于发病48 h内行血管内栓塞动脉瘤,术中无出血,给予常规抗血管痉挛治疗。发病4~9 d内21例患者均出现SCVS,遂行超选动脉内半量全身肝素化,持续30 min滴注法舒地尔（30 mg加250 ml生理盐水）,滴注后15 min造影复查并对照分析给药前后美国国立卫生研究院卒中量表（NIHSS）评分。结果术后影像学显示显著改善15例,无明显变化6例；临床症状显著改善11例,部分改善4例,无变化6例。NIHSS评分由治疗前平均28.6分改善为治疗15 min后平均21.2分。结论动脉内超选滴注法舒地尔治疗SCVS起效迅速、安全有效,有较好的临床应用价值。
목적：탐토동맥내초선적주법서지이결합상규항혈관경련법치료증상성뇌혈관경련（SCVS）즉시림상효과。방법회고성분석2010년5월지2014년2월동맥류성주망막하강출혈환자21례（FisherⅡ급2례、Ⅲ급16례、Ⅳ급3례）。전뇌혈관DSA조영학진로내동맥류병우발병48 h내행혈관내전새동맥류,술중무출혈,급여상규항혈관경련치료。발병4~9 d내21례환자균출현SCVS,수행초선동맥내반량전신간소화,지속30 min적주법서지이（30 mg가250 ml생리염수）,적주후15 min조영복사병대조분석급약전후미국국립위생연구원졸중량표（NIHSS）평분。결과술후영상학현시현저개선15례,무명현변화6례；림상증상현저개선11례,부분개선4례,무변화6례。NIHSS평분유치료전평균28.6분개선위치료15 min후평균21.2분。결론동맥내초선적주법서지이치료SCVS기효신속、안전유효,유교호적림상응용개치。
Objective To investigate the instant clinical efficacy of intra-arterial infusion of fasudil combined with routine anti-vasospasm for symptomatic cerebral vasospasm (SCVS). Methods The clinical data of 21 patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm, who were admitted to authors' hospital during the period from May 2010 and February 2014, were retrospectively analyzed. The lesions included Fisher gradeⅡ(n=2), gradeⅢ (n=16) and gradeⅣ (n=3). Endovascular embolization of the aneurysm was carried out within 48 hours after the confirmation of the diagnosis with total cerebral DSA;no bleeding occurred during the operation and routine anti-vasospasm therapy was given. Within 4-9 days after the onset of the disease, all 21 patients presented SCVS. Half dose systemic heparinization, superselective intra-arterial infusion of fasudil (30 mg fasudil+250 ml saline, lasting for 30 min) were adopted. Reexamination of angiography performed at 15 min after fasudil infusion was employed, and the results were evaluated with NIHSS score by comparing the preoperative findings. Results Imaging examination performed after the treatment showed that significant improvement was obtained in 15 patients and no obvious changes in 6 patients. Clinical symptoms were remarkably improved in 11 patients, partially improved in 4 patients and remained unchanged in 6 patients. The mean NIHSS score was improved from preoperative 28.6 to postoperative 21.2. Conclusion For the treatment of symptomatic cerebral vasospasm, superselective intra-arterial infusion of fasudil is effective and safe, and it has good clinical application value.