Nimodipine for treatment of perifocal edema following aspiration and drainage in patients with cerebral hemorrhage

Abstract

BACKGROUNDAfter cephalophyma removal, perifocal edema does not disappear subsequently, but progresses occasionally. Nimodipine can improve cerebral blood flow, so it maybe reduce cerebral edema area, and speed up the absorption of edematous fluid. OBJECTIVETo observe the effect of nimodipine on perifocal edema area and neurologic function in patients with hypertensive intracerebral hemorrhage (HICH) following stereotaxic aspiration. DESIGNClinical controlled observation. SETTINGDepartment of Neurology, Third Hospital Affiliated to Liaoning Medical University. PARTICIPANTSTotally 116 HICH inpatients admitted to the Department of Neurology, Third Hospital Affiliated to Liaoning Medical University from January 2003 to January 2005 were involved in this experiment. They all met the classification and diagnosis of cerebrovascular disease proposed in 1995 4th National Conference on Cerebrovascular Disease. The bleeding volume ≥ 35 mL was confirmed by skull CT. The involved patients, 64 male and 52 femlae, averaged 63 years old, ranging from 40 to 70 years. All the patients suffered from unilateral cerebral hemisphere hemorrhage, and muscle strength of paralyzed limb was less than degree III. Informed consents of therapeutic items were obtained from all the patients and relatives. METHODS(1) According to different wills, the patients were assigned into treatment group (n = 60) and control group (n = 56). In the treatment group, the involved patients, 32 male, 28 female, averaged 63 years. They underwent operation and administration of nimodipine. In the control group, the involved patients, 30 male and 26 female, averaged 62 years old. They all underwent operation simply. Patients in the two groups all received stereotaxic aspiration, drainage, dehydration, haemostasis, antiinflammation, blood pressure controlling and other treatments. Patients in the treatment group were also intravenously injected with 0.2 g/L nimodipine(Bayer Medicine Health Care Co., Ltd., Lot No. 021127) at 10 mg/d. One course of treatment was 15 days. (2) According to the clinical neurologic function deficit score of stroke proposed in the 4th National Conference on Cerebrovascular Disease (mild: 0 – 15 points; moderate: 16 – 30 points; severe: 31 – 45 points), neurologic function deficit score and the largest perifocal edema area of patients in two groups were recorded on the 1th, 7th and 15th days after operation. The differences in perifocal edema area and neurologic deficit score between on the 1st and 7th days and between on the 7th and 15th days were calculated. MAIN OUTCOME MEASURESChanges in the neurologic function deficit score and the largest perifocal edema area. RESULTSTwo of treatment group and 16 of control group died. Finally, 98 patients participated in the final analysis. (1) in the treatment group, the difference in the largest perifocal edema area on the postoperative 7th and 15th days and on the 1st day was (1.02±0.07) and (1.86±0.10) cm2, respectively, which changed more significantly as compared with control group, respectively [(0.02±0.04), (0.61±0.09) cm2, P < 0.01]. (2) The difference in neurologic function deficit score between on the postoperative 15th and 1st days in the treatment group was larger than that in the control group [(7.23±0.22), (2.68±0.32) points, P < 0.01]. CONCLUSIONNimodipine obviously reduces perifocal edema area of patients with cerebral hemorrhage following aspiration and drainage, and promotes the recovery of neurologic function.