Comparative Analysis Of The Effect On Cerebral Vasospasm In Patients With Aneurysm After The Application Of Papaverine And Nimodipine In The Operation Area

Objective To compare effects of papaverine and nimodipine in operating area onprevention from cerebral vasospasm in144patients with anterior communicating artery （ACA）aneurysm and98cases with middle cerebral artery （MCA） aneurysm by clipping.Materials and Methods According inclusion criteria242patients with intracranialaneurysms including144anterior communicating artery （ACA） and98middle cerebral artery（MCA） were treated by clipping and analysed retrospectively in the General Hospital of NingxiaMedical University from2004to2011. The patients with ACA and MCA aneurysms weredivided into two groups: papaverine group and nimodipine group, for ACA78cases withpapaverine and66cases with nimodipine,for MCA56and42cases respectively. The factorsthat affect cerebral vasospasm were controled strictly between the two groups at pre-andpostoperations. The CVS were diagnosed by clinical criteria and review of imaging fromComputer Tomography Angiography, Computer Tomography and Transcranial Doppler. Theincidence of CVS at1days,3days,7days after operation and neurological function conditions（GOS） at discharge were compared between two groups.Results There were not statistically significant differences in age, Hunt-Hess scale andFisher’scale between the two groups for ACA and MCA before the surgery. For patients withACA aneurysm, the total incidence of CVS was48.72%in application of papaverine group, ofwhich53.85%,48.72%,43.59%at1,3and7days respectively after operation; the totalincidence of CVS was28.28%in application of nimodipine group, of which34.58%,30.30%,18.18%at1,3,7days respectively after operation; the incidencs of CVS between two groups were compared by chi-square test, the results showed that there were significant differences at1(χ_α=0.05²=5.210, P=0.022),3(χ_α=0.05²=4.222, P=0.040), and7(χ_α=0.05²=10.616, P=0.001) days.For patients with MCA aneurysm, the total incidence of CVS was48.81%in application ofpapaverine group, of which57.14%,60.71%,51.79%at1,3and7days respectively afteroperation; the total incidence of CVS was27.78%in application of nimodipine group, of which35.71%,38.10%,26.20%at1,3,7days respectively after operation; the incidencs of CVSbetween two groups were compared by chi-square test, the results showed that there weresignificant differences at1(χ_α=0.05²=4.416, P=0.036),3(χ_α=0.05²=4.914, P=0.027), and7(χ_α=0.05²=6.509, P=0.011) days. The neurological function conditions （GOS） at discharge werecompared by Wilcoxon rank sum test between papaverine and nimodipine groups totaly, theresults showed that there were significant differences (Z_α=0.05=-2.168, P=0.03for ACA,Z_α=0.05=-2.058, P=0.040for MCA), the nimodipine group were better than papaverine group（P<0.05）.Conclusion （1） Both papaverine and nimodipine intraoperative lavage is safe andeffective, and could significantly reduce the incidence of cerebral vasospasm after operation.（2）The incidence of cerebral vasospasm in the patients with Papaverine group is significantlyhigher than nimodipine group both appication of local lavage during the clipping, which cansignificantly improve the neurological status of patients discharged from hospital and improveprognosis, it is worth of clinical application and promotion.