Abstract
Objective: To investigate the therapeutic effect of Shenmai Injection on postoperative cerebral vasospasm in patients with ruptured aneurysms. Methods: Seventy patients undergoing craniotomy for ruptured aneurysms in our hospital were selected as study subjects and randomly divided into control (n = 33) and research (n = 37) groups, they were treated with nimodipine and nimodipine combined with Shenmai injection after operation. The blood flow velocity in the middle cerebral artery (MCA) before and at 1, 3, 7, 11 and 14 days after surgery and the incidence of cerebral vasospasm during these days were compared, and the GCS scores at 14 days postoperatively and GOS scores at 6 months postoperatively were compared between the two groups. Results: There were no statistically significant differences in the occurrence of cerebral vasospasm, GCS or GOS scores between the two groups (P > 0.05), but the period of postoperative cerebral vasospasm in the study group was significantly shorter than that in the control group. Conclusion: Shenmai injection has the effect of shortening the cycle of occurrence of cerebral vasospasm after the operation of ruptured aneurysms, promoting patients to recover as early as possible and reducing their physical and mental burden.
Highlights
Subarachnoid hemorrhage (SAH) is an acute and severe cerebrovascular disease with an incidence of approximately 2-22/100,000 persons per year, of which about 85% is associated with spontaneous rupture of intracranial basilar artery aneurysms with a mortality rate as high as 35%, 1/3 of survivors require lifelong care, and another 1/3 experience residual cognitive impairment [1] [2] [3] [4]
70% - 90% of patients with aSAH will develop cerebral vasospasm, of which approximately 70% are transient, early-onset constrictions of vessels triggered by mechanical stimuli, termed angiographic cerebral vasospasm or asymptomatic vasospasm; about 30% are late-onset cerebral vasospasm or symptomatic vasospasm, which usually occurs 3 - 13 days after aSAH and is most commonly observed on postoperative day 8
The main mechanisms of delayed cerebral vasospasm are as following: 1) the imbalance between endothelial relaxing factors dominated by nitric oxide (NO) and vasoconstriction factors represented by endothelin-1 (ET-1), as well as the blockade of calcium channels, lead to reversible vasoconstriction [16] [17] [18]; 2) a large number of immune inflammatory mediators are released in a cascade, upregulating the expression of cytokines such as C-reactive protein, monocyte chemokine, tumor necrosis factor (TNF-α), IL-1, IL-6, and IL-8, accompanied by neutrophil activation [19] [20] [21] [22]; 3) oxyhemoglobin released from erythrocyte degradation in aSAH leads to vasospasm by directly stimulating smooth muscle to contract, releasing vasoactive substances, producing lipid peroxides, and so on [15] [23] [24]; 4)
Summary
Subarachnoid hemorrhage (SAH) is an acute and severe cerebrovascular disease with an incidence of approximately 2-22/100,000 persons per year, of which about 85% is associated with spontaneous rupture of intracranial basilar artery aneurysms with a mortality rate as high as 35%, 1/3 of survivors require lifelong care, and another 1/3 experience residual cognitive impairment [1] [2] [3] [4]. Cerebral ischemia induced by persistent constriction of intracranial arteries leads to neurological deficits in patients and is an important cause of aggravation and even death in patients after aneurysm surgery, which seriously compromises the curative effect [5] [6]. Because nimodipine alone still has limitations for preventing and treating CVS, in this study, we sought to observe the clinical efficacy of Shenmai injection for preventing CVS after treatment of ruptured aneurysms on the basis of maintaining the necessary dosage of nimodipine. This clinical research had met with approval of the clinical ethics committee of the Zhuji Affiliated Hospital of Shaoxing University. Written informed consent had been obtained from patients participating in the study
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