动脉瘤性蛛网膜下腔出血后尼莫地平:在未选择的患者队列中缩短治疗时间

IF 2.5 Q3 CLINICAL NEUROLOGY
Bryndís Baldvinsdóttir , Peo Wästberg , Björn M. Hansen , Erik Uvelius , Erik Kronvall
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引用次数: 0

摘要

尼莫地平通过减轻延迟性脑缺血(DCI)改善动脉瘤性蛛网膜下腔出血(aSAH)后的预后。大多数研究都是基于21天的治疗时间。在我们的机构,临床实践是给予尼莫地平14天,无论出血严重程度。如果出现DCI的体征或症状,则延长治疗时间。本研究旨在回顾这一实践。方法回顾性分析aSAH患者的前瞻性队列,并将尼莫地平治疗的相关信息添加到该数据库中。使用格拉斯哥结局量表(GOSE)在发病后一年测量功能结局,并将其分为不利和有利结果。放射学结果的定义是卒中后30天脑成像上出现新的脑梗死。结果研究人群包括164例患者,其中97例(59%)接受尼莫地平治疗14天或更短。27%的患者出现不良结果,17%的患者出现脑梗死。两项结果测量与先前发表的研究相似。停止尼莫地平后未见再入院或DCI迹象。结论缩短尼莫地平治疗aSAH后无DCI患者的疗程是可行的。这可能会减少患者的睡眠剥夺,更有效地利用神经重症监护资源。对于没有DCI体征和症状的患者,较短的尼莫地平治疗是否足以充分发挥药物的作用,需要一项大型的随机研究来回答这个问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Nimodipine after aneurysmal subarachnoid hemorrhage: shortened treatment in an unselected patient cohort

Background

Nimodipine improves outcome after aneurysmal subarachnoid hemorrhage (aSAH) through mitigation of delayed cerebral ischemia (DCI). Most studies are based on a treatment duration of 21 days. At our institution, clinical practice is to administer nimodipine for 14 days, regardless of bleeding severity. Treatment is prolonged if signs or symptoms of DCI occurs. The present study aims to review this practice.

Methods

A prospective cohort of aSAH patients was reviewed and relevant information regarding nimodipine treatment were retrospectively added to this database. Functional outcome was measured using Glasgow outcome scale extended (GOSE) one year after ictus and dichotomized into unfavorable and favorable outcome. Radiological outcome was defined by the occurrence of new cerebral infarctions on brain imaging later than 30 days post-ictus.

Results

The study population comprised 164 patients, out of which 97 (59 %) received nimodipine for 14 days or less. Unfavorable outcome was noted in 27 % of patients and brain imaging found cerebral infarctions in 17 % of patients. Both outcome measures were similar to previously published studies. No readmissions or signs of DCI were seen after discontinuation of nimodipine.

Conclusions

A shortened nimodipine treatment period in patients without DCI after aSAH could be feasible. This may reduce sleep deprivation of patients and more effective utilization of neurointensive care resources. A large, randomized study is required to answer the question whether a shorter treatment with nimodipine is adequate to give full benefit of the medication in patients without signs and symptoms of DCI.
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来源期刊
Brain & spine
Brain & spine Surgery
CiteScore
1.10
自引率
0.00%
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审稿时长
71 days
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