CEREBRAL ARTERIAL SPASM - A CONTROLLED TRIAL OF NIMODIPINE IN PATIENTS WITH SUBARACHNOID HEMORRHAGE
CEREBRAL ARTERIAL SPASM - A CONTROLLED TRIAL OF NIMODIPINE IN PATIENTS WITH SUBARACHNOID HEMORRHAGE
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DOI：
10.1056/nejm198303173081103
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发表时间：
1983-01-01
影响因子：
158.5
通讯作者：
TRANSOU, CR
中科院分区：
文献类型：
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作者：
ALLEN, GS;AHN, HS;TRANSOU, CR
患有颅内动脉瘤的神经系统正常患者 [125] 在蛛网膜下腔出血后 96 小时内参加了一项多机构、前瞻性、双盲、随机、安慰剂对照试验，以确定用 Ca 阻滞剂尼莫地平治疗是否可以预防或减轻动脉痉挛引起的缺血性神经功能缺损的严重程度。在 21 天治疗期结束时，60 名服用安慰剂的患者中有 8 名出现脑动脉痉挛所致的缺陷，这种缺陷持续存在且严重或导致死亡，而 56 名接受尼莫地平的患者中有 1 名出现这种情况（P = 0.03，Fisher 精确检验）。对因痉挛导致缺陷的患者进行入院前 CAT（计算机轴向断层扫描）扫描时基础蛛网膜下腔血量的分析表明，与接受安慰剂的患者的情况不同，接受尼莫地平治疗的患者蛛网膜下腔血量的增加与神经系统结局较差无关。尼莫地平没有副作用。显然，蛛网膜下腔出血后神经功能正常的患者应给予尼莫地平，以减少脑动脉痉挛导致严重神经功能缺损的发生。
Neurologically normal patients [125] with intracranial aneurysms were enrolled in a multi-institution, prospective, double-blind, randomized, placebo-controlled trial within 96 h of their subarachnoid hemorrhage, to determine whether treatment with the Ca blocker nimodipine would prevent or reduce the severity of ischemic neurologic deficits from arterial spasm. A deficit from cerebral arterial spasm that persisted and was severe or caused death by the end of the 21-day treatment period occurred in 8 of 60 patients given placebo and in 1 of 56 given nimodipine (P = 0.03, Fisher''s exact test). Analysis of the amount of basal subarachnoid blood on pre-entry CAT [computed axial tomography] scans in patients with deficits from spasm showed that an increase in subarachnoid blood was not associated with a worse neurologic outcome among patients who received nimodipine, unlike the situation in patients given a placebo. There were no side effects from nimodipine. Evidently, nimodipine should be given to patients who are neurologically normal after subarachnoid hemorrhage to reduce the occurrence of severe neurologic deficits due to cerebral arterial spasm.