陈立波 朱迪 梁旭光

【摘要】 目的：探讨尼莫地平联合微创穿刺抽吸术治疗对高血压性脑出血（hypertensive cerebral hemorrhage，HCH）患者脑血流动力学的影响。方法：选取2018年1月-2019年12月本院收治的HCH患者72例，依据不同治疗方式分成对照组和研究组，各36例。对照组使用微创穿刺抽吸术治疗，研究组在对照组基础上联合应用尼莫地平。比较两组的临床总有效率，治疗前后的NIHSS评分水平、临界压力（CP）、平均血流量（Qmean）、外周阻力（Rv）及平均血流速度（V）水平。结果：研究组的总有效率高于对照组，差异有统计学意义（P<0.05）。治疗后7、14 d，研究组NIHSS評分均低于对照组，差异均有统计学意义（P<0.05）。治疗后，研究组患侧CP、Qmean、Rv及V水平与治疗前、对照组比较，差异均有统计学意义（P<0.05）。结论：给予HCH患者联合使用尼莫地平与微创穿刺抽吸术进行治疗可显著提高有效率，降低患者的NIHSS评分，改善患者的脑血流动力学指标水平，促进脑部血液的循环。

【关键词】 高血压性脑出血 尼莫地平 微创穿刺抽吸术 脑血流动力学

Effect of Nimodipine Combined with Minimally Invasive Puncture-aspiration on Cerebral Hemodynamics in Patients with Hypertensive Cerebral Hemorrhage/CHEN Libo， ZHU Di， LIANG Xuguang. //Medical Innovation of China， 2021， 18（01）： 0-080

[Abstract] Objective： To investigate the effect of Nimodipine combined with minimally invasive puncture-aspiration on cerebral hemodynamics in patients with hypertensive cerebral hemorrhage （HCH）. Method： A total of 72 HCH patients admitted to our hospital from January 2018 to December 2019 were selected and divided into the control group and the study group， according to different treatment methods， 36 cases in each group. The control group was treated with minimally invasive puncture-aspiration， the study group was based on the control group treated with Nimodipine. The clinical total effective rate， NIHSS score level， critical pressure （CP）， mean blood flow （Qmean）， peripheral resistance （Rv）， and mean blood flow velocity （V） levels before and after treatment were compared between the two groups. Result： The total effective rate of the study group was higher than that of the control group， the difference was statistically significant （P<0.05）. 7 and 14 days after treatment， NIHSS scores in the study group were lower than those in the control group， the differences were statistically significant （P<0.05）. After treatment， the CP， Qmean， Rv and V levels of the affected side in the study group were statistically significant compared with those before treatment and in the control group （P<0.05）. Conclusion： The combination of Nimodipine and minimally invasive puncture-aspiration can significantly improve the effective rate， reduce the NIHSS score， improve the level of cerebral hemodynamic indexes， promote the circulation of blood in the brain.

[Key words] Hypertensive cerebral hemorrhage Nimodipine Minimally invasive puncture-aspiration Cerebral hemodynamics

First-authors address： Chifeng City Hospital of Inner Mongolia， Chifeng 024000， China

doi：10.3969/j.issn.1674-4985.2021.01.020

高血压性脑出血（hypertensive cerebral hemorrhage，HCH）在临床当中好发于年龄超过50岁的中老年群体[1]。导致患者发病的主要原因为血压水平升高使得单位血管面积当中的血液增加对管壁产生的压力，而这一压力已经远远超过血管壁自身弹性能够承受的压力范围，进而使得血管发生破裂并出血，对脑组织产生挤压，导致脑组织发生移位，颅内压力水平增高，以致患者发病[2]。与此同时，发病时血管会出现痉挛，使得血管的管腔变狭窄，不能正常的通过血流，时间一长就会导致血管被堵塞而发生栓塞，出现脑部缺氧，对血肿的吸收产生不利影响[3]。微创穿刺抽吸术是临床中对HCH患者进行治疗时的一种常用微创外科手术治疗方式。尼莫地平属于钙拮抗剂类药物，可以十分容易的通过自身的血脑屏障，在神经细胞及脑血管发生作用，同时还能够对脑血管产生选择性的扩张作用，使得脑血流量增加的同时不会对脑代谢产生影响[4]。……