HYPOTENSIVE EFFECT OF NIMODIPINE DURING TREATMENT FOR ANEURYSMAL SUBARACHNOID HEMORRHAGE
HYPOTENSIVE EFFECT OF NIMODIPINE DURING TREATMENT FOR ANEURYSMAL SUBARACHNOID HEMORRHAGE
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DOI：
10.1007/bf02188783
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发表时间：
1995-01-01
影响因子：
2.4
通讯作者：
DETRIBOLET, N
中科院分区：
文献类型：
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作者：
PORCHET, F;CHIOLERO, R;DETRIBOLET, N
为确定蛛网膜下腔出血（SAH）患者尼莫地平治疗后诱导性低血压的发生率，对87例连续病例进行了回顾性分析，所有患者均按照相同的尼莫地平治疗方案进行治疗。在确认SAH后，尼莫地平治疗以0.5 mg/h的剂量作为连续静脉灌注开始，如果血流动力学耐受，则每6小时逐渐增加，直到达到2 mg/h的维持剂量。持续测量中位体循环压力并耐受，直至最低限度为75 mmHg。在31例患者（36%）中，观察到至少30分钟内低血压值低于75 mmHg，需要减少尼莫地平。静脉注射尼莫地平引起低血压26例，口服5例。38%的患者需要血管活性药物（多巴胺或去甲肾上腺素）的支持，尼莫地平减量组与正常剂量组迟发性缺血性恶化的发生率无显著性差异，表明尼莫地平剂量逐渐增加仍有诱发低血压的危险。通过进一步诱导高血容量伴随血管活性药物纠正低血压可导致严重的血液动力学情况。因此，我们建议口服尼莫地平。
To determine the incidence of induced systemic hypotension in patients after aneurysmal subarachnoid haemorrhage (SAH) and nimodipine treatment 87 consecutive cases were reviewed.The patients were managed according to the same Nimodipine treatment protocol. After confirmation of SAH the nimodipine treatment was started as a continuous intravenous perfusion at a dosage of 0.5 mg/h and gradually increased every 6 hours if haemodynamically tolerated until the maintenance dose of 2 mg/h was reached. Median systemic pressure was continuously measured and tolerated until a lowest limit of 75 mmHg. In 31 patients (36%) hypotension with values below 75 mmHg during at least 30 minutes was noted and needed Nimodipine reduction. Intravenous Nimodipine administration was responsible for hypotension in 26 cases as compared to 5 cases due to oral administration. 38% of all patients required support by vase-active agents (Dopamine or Noradrenaline).There was no statistically significant difference of incidence of delayed ischaemic deterioration comparing the Nimodipine-reduction group with the normal dose group.This study demonstrates that a considerable risk exists of Nimodipine induced hypotension in intravenous administration despite gradually increasing the doses. Correction of hypotension through further induced hypervolaemia accompanied by vasoactive agents can lead to critical haemodynamic situations. We therefore recommend oral Nimodipine administration.