| Objectives To analyze the effect of different therapeutic doses of nimodipine to improve CVS after tSAH and prognosis of CVS after tSAH by TCD and GOS were compared different between the treatment dose efficacy, obtained the optimal therapeutic dose, provided reliable quantitative data for clinical prevention and treatment of CVS.Method (1) Grouping:We were selected120cases tSAH patients(GCS3-12, average8.4).They were randomly divided into three groups. Three groups were given the conventional treatment. The first treatment group on the basis of conventional therapy, were given nimodipine1mg/hour continuous intravenous infusion, and two weeks of continuous useing. And given nimodipine of oral30mg/3times/day after two weeks, continuous used for12-24weeks. The second treatment group on the basis of conventional therapy, were given nimodipine2mg/hour continuous intravenous infusion, and two weeks of continuous useing. And given nimodipine of oral30mg/3times/day after two weeks, continuous used for12-24weeks.(2) CVS evaluation: The flow velocity of middle cerebral artery were detected24hours,72hours,7days,14days after treatment by TCD. And the flow velocity of each groups were taked the statistical comparison.(3) Prognosis evaluation:Patients were followed for three months in each group after treatment, and evaluated prognosis by GOS. Prognosis are classified into good, moderate disability, severe disability, vegetative, died. The outcome were taked the statistical comparison.Results (1) The flow velocity of middle cerebral artery which were detected24hours,72hours,7days,14days after treatment by TCD were54.2±2.3cm/s,86.4±2.5cm/s, and130.3±3.0cm/s, and90.1±1.9cm/s in the control group. The outcome of prognosis evaluation were good in17cases (42.5%), residues in seven cases (17.5%), severe disability in5cases (12.5%), plant survival in3cases (7.5%) died in8cases (20.0%).(2) The flow velocity of middle cerebral artery which were detected24hours,72hours,7days,14days after treatment by TCD were46.5±3.1cm/s,67.9±1.8cm/s, and88.6±2.5cm/s, and86.2±2.1cm/s in the first treatment group. The outcome of prognosis evaluation were good in25cases (62.5%), residues in seven cases (17.5%), severe disability in3cases (7.5%), plant survival in two cases (5.0%), died in three cases (7.5%).(3) The flow velocity of middle cerebral artery which were detected24hours,72hours,7days,14days after treatment by TCD were48.4±2.9cm/s,64.6±1.7cm/s, and75.9±2.3cm/s, and70.4±1.8cm/s in the second treatment group. The outcome of prognosis evaluation were good in26cases (65.0%), residues in seven cases (17.5%), severe disability in3cases (7.5%), plant survival in two cases (5.0%), died in two cases (5.0%).(4) Compared to the control group, the flow velocity of middle cerebral artery were reduced by14.2%,19.3%,32.0%,4.3%in the first treatment group. The flow velocity of middle cerebral artery were reduced by14.2%,19.3%,32.0%,4.3%in the second treatment group. The difference of the flow velocity of middle cerebral artery had statistically significant between the control group and treatment groups. The difference of the flow velocity of middle cerebral artery had statistically significant between the first treatment group and the second treatment group in72hours,7days,14days after treatment.(5) Compared to the control group, the outcome of prognosis evaluation were improved by20.0%,0,5.0%,2.5%,12.5%in the first treatment group, the outcome of prognosis evaluation were improved by22.5%,0,5.0%,2.5%,15%in the second treatment group. The difference of the outcome of prognosis evaluation had statistically significant between the control group and treatment groups. The difference of the outcome of prognosis evaluation had no statistically significant between the first treatment group and the second treatment group.Conclusion (1) CVS after SAH began in the first3days after traumatic brain injury, reached a peak at about7days.(2) The therapeutic effect of CVS after tSAH was alleviated by using nimodipine.(3)CVS after tSAH was reduced by using nimodipine. (4) The capability that alleviated reduced CVS after tSAH by higher treatment doses of nimodipine t is superior to the lower therapeutic dose’s;(5) No significant difference in treatment effect of improving prognosis of CVS after tSAH between different doses of nimodipine was certificated. The prognosis was not directly related at nimodipine dose size. |
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