本文選題：尼莫地平　切入點(diǎn)：顱內(nèi)動(dòng)脈瘤　出處：《安徽醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：在動(dòng)脈瘤開顱顯微夾閉術(shù)中，將50ml尼莫地平溶液（10mg/50ml,德國(guó),拜耳公司）與生理鹽水500ml配成1:10的溶液進(jìn)行術(shù)區(qū)灌洗，探討尼莫地平在顱內(nèi)動(dòng)脈瘤夾閉術(shù)術(shù)中灌洗的臨床療效 方法：本課題回顧性分析2012年1月至2013年4月,我院收治經(jīng)CTA或DSA確診Hunt-Hess分級(jí)在I-III級(jí)并選擇動(dòng)脈瘤夾閉術(shù)的60例患者，根據(jù)術(shù)中是否應(yīng)用尼莫地平灌洗將其分為兩組，即灌洗組（術(shù)中應(yīng)用尼莫地平灌洗）和對(duì)照組（術(shù)中未應(yīng)用尼莫地平灌洗）。灌洗組30例患者，男15例，女15例，年齡33-72歲，平均（51.57±9.863）歲，前交通（或大腦前）動(dòng)脈瘤12例，大腦中（或頸內(nèi)）動(dòng)脈瘤8例，頸內(nèi)-后交通動(dòng)脈瘤10例。對(duì)照組30例患者，男10例，女20例，年齡22-70歲，平均（52.6±10.660）歲，前交通（或大腦前）動(dòng)脈瘤14例，大腦中（或頸內(nèi)）動(dòng)脈瘤6例，頸內(nèi)-后交通動(dòng)脈瘤10例。對(duì)兩組術(shù)后第1天CT影像改變、出院時(shí)和隨訪時(shí)預(yù)后（改良Rankin評(píng)分表）進(jìn)行比較分析。 結(jié)果：灌洗組出院時(shí)預(yù)后平均評(píng)分為（1.17±1.533）分，對(duì)照組出院時(shí)預(yù)后平均評(píng)分（1.37±1.752）分， P值（0.640）大于0.05；灌洗組隨訪時(shí)預(yù)后平均評(píng)分為（1.10±1.423）分，對(duì)照組隨訪時(shí)預(yù)后平均評(píng)分（1.30±1.664）分，P值（0.619）大于0.05；灌洗組術(shù)后第一天CT影像上出現(xiàn)梗死灶例數(shù)為4（13.3%），對(duì)照組術(shù)后第一天CT影像上出現(xiàn)梗死灶例數(shù)為3（10.0%），，P值（1.000）大于0.05。灌洗組和對(duì)照組術(shù)后第1天梗死率、出院時(shí)和隨訪時(shí)預(yù)后平均評(píng)分差異均無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論：尼莫地平術(shù)中灌洗對(duì)患者的術(shù)后第一天梗死率、出院時(shí)和隨訪時(shí)預(yù)后并無(wú)改善，術(shù)中應(yīng)用尼莫地平灌洗無(wú)臨床價(jià)值，但還需要增加樣本量或進(jìn)一步設(shè)計(jì)多中心前瞻性隨機(jī)對(duì)照研究，以便得到更加有說服力的結(jié)論。
[Abstract]:Objective: to study the clinical effect of nimodipine in intracranial aneurysm clipping operation by using 10 mg / 50 ml of 50ml nimodipine solution and normal saline 500ml as 1:10 solution during microclipping of aneurysm. Methods: from January 2012 to April 2013, 60 patients with Hunt-Hess grade of I-III diagnosed by CTA or DSA and selected for aneurysm clipping were retrospectively analyzed. The patients were divided into two groups according to whether Nimodipine was used in operation or not. There were 30 patients in the lavage group (15 males and 15 females, aged 33-72 years, mean 51.57 鹵9.863 years), 12 patients with anterior communicating (or anterior cerebral) aneurysm. In the control group, there were 30 patients (male 10, female 20, aged 22-70 years, mean 52.6 鹵10.660 years old), and 14 cases of anterior communicating (or anterior cerebral) aneurysm. There were 6 cases of middle or internal carotid aneurysms and 10 cases of internal and posterior communicating artery aneurysms. The changes of CT images on the first day after operation and the prognosis (modified Rankin scale) at discharge and follow-up were compared between the two groups. Results: the mean prognostic score at discharge was 1.17 鹵1.533 in lavage group, 1.37 鹵1.752 in control group (P < 0.640), and 1.10 鹵1.423 in lavage group. In the control group, the mean prognostic score was 1.30 鹵1.664 (P = 0.619) > 0.05, and the number of infarcted lesions on CT images on the first day after operation in the lavage group was 413.3%, and on the first day after operation in the control group, the number of infarcted foci on CT images of the control group was 3% 10.0% (P = 1.000) > 0.05.In the lavage group, the number of infarcts appeared on CT images was higher than that in the control group. And the infarct rate of the control group on the first day after operation, There was no significant difference in mean prognostic score at discharge and follow-up (P 0.05). Conclusion: Nimodipine intraoperative lavage has no effect on the rate of infarction on the first day after operation, and the prognosis at discharge and follow-up. Nimodipine is of no clinical value during operation. But there is a need to increase the sample size or to further design a multicenter prospective randomized controlled study in order to obtain a more convincing conclusion.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R739.41

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相關(guān)期刊論文 前2條

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本文編號(hào)：1653540