Comparison Of Effect Between Papaverine And Nimodipine On Cerebral Vasospasm In Patients With Aneurysmal Subarachnoid Hemorrhage

Objective: To compare the effect between papaverine and nimodipine on cerebral vasospasm in 116 patients with aneurysmal subarachnoid hemorrhage in order to constitute individualized Rx for clinical works.Data and Methods: The patients with aneurysmal subarachnoid hemorrhage were divided into three groups: papaverine group(n=51), nimodipine group(n=34) and control group(n=31).All the patients underwent the neurosurgical clipping by the same operator.Local lavage during the clipping and postoperative systemic application were performed. We compared the following factors among these three groups:age, Hunt-Hess scale, Fisher'scale,the incidence of cerebral vasospasm, imaging examination on the 7th day and the 14th day after operation, intracranial infections, the changes of liver function,intracranial infection,neural functional status at discharge.Results: There isn't statistically significant difference in age,Hunt-Hess scale and Fisher'scale among the three groups.The data of the three groups are comparable.In our study, the total incidence of cerebral vasospasm is 37.93%,and the incidence of vasospasm in Fisher scale grade 3-4 level, Hunt-Hess scale gradeâ…¢-â…¤level and patients with delayed operation(72hours-10days) are 55.56%(20/36),64.71%(22/34),54.05%( 20/37) respectively.The incidence of cerebral vasospasm in Fisher scale grade 3-4 level(55.56%) is significantly higher than that in the Fisher scale grade 1-2 level(30.0%,24/80)(P<0.05).The incidence of cerebral vasospasm in Hunt-Hess scale gradeâ…¢-â…¤level(64.71%) is significantly higher than that in the Hunt-Hess scale gradeâ… -â…¡level (26.83%,22/82)(P<0.05). The incidence of cerebral vasospasm in the patients with delayed operation (72hours-10days) ( 56.76%) is significantly higher than that in the patients with either early operation(within 72hours) ( 30.61%, 15/49) ( P<0.025) or later operation(after 10 days) ( 26.67%, 8/30) ( P<0.025).But there is no significant difference between early operation and later operation.The incidence of cerebral vasospasm in the control group is significantly higher than that in either papaverine group( 31.37%, 16/51) ( P<0.025) or nimodipine group( 29.41%, 10/34) ( P<0.025). But there is no significant difference between early operation and later operation.The positive results in the imaging examination on the 7th day after operation are 8 in the papaverine group,5 in the nimodipine group and 6 in the control group respectively.While the results on the 14th day after operation are 3 in the papaverine group,4 in the nimodipine group and 4 in the control group respectively.The comparison of the neural functional status at discharge:81 good recovery,16 moderate disability,11 severe disability,5 vegetative state,3 dead(all are in control group).The proportion of the good recovery among the three groups are 76.47%(39/51) for the papaverine group and 79.41%(27/34) for the nimodipine group,which are significantly higher than 51.61%(16/31) for the control group(P<0.025).Complications and side effects:1.intracranial infections:4 in the papaverine group,1 in the nimodipine group,2 in the control group.2.abnormal liver function:5 patients in the nimodipine group showed liver function abnormity,the data are ALT 80 U/L,AST75U/L,ALT 112 U/L,AST65 U/L,ALT97 U/L,AST 105U/L.But there aren't any cases liver function abnormity in papaverine group or control group.Conclusion:1. The incidence of cerebral vasospasm in Fisher scale grade 3-4 level is significantly higher than that in the Fisher scale grade 1-2 level.The incidence of cerebral vasospasm in Hunt-Hess scale gradeâ…¢-â…¤level is significantly higher than that in the Hunt-Hess scale gradeâ… -â…¡level. The incidence of cerebral vasospasm in the patients with delayed operation is significantly higher than that in the patients with early operation and later operation.2.Both papaverine and nimodipine can effectively reduce the incidence of cerebral vasospasm,but there is not significant difference between them by ways of local lavage during the clipping and postoperative systemic application.The difference of effect between them by other administrations needs further relevant studies to be proofed.3.The metigative effect of papaverine on the early cerebral vasospasm is stronger than that of nimodipine .While neither of them is effective on deleyed cerebral vasospasm and they had no direct impact on the prognosis.Further studies are needed to test the conclusion.