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脑膜中枢动脉输液用于动脉瘤下arachnoid出血后的头痛:一个试点研究

Tongyu Zhang¹, Matias Luis Costa², Magdy Selim³

¹Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Journal of neurointerventional surgery

|October 21, 2025

概括

中脑膜动脉输注利多卡因 (含或不含德甲) 提供了一种安全有效的策略,可以减少动脉瘤后脑底下出血头痛和阿片类药物消耗. 这种向治疗显示出持续缓解疼痛的前景.

科学领域:

神经外科神经外科
疼痛管理疼痛管理
血管神经学血管神经学

背景情况:

头痛是动脉瘤下arachnoid出血 (aSAH) 后的频繁和衰弱的并发症.
脑膜炎症和持续性恶感受体的激活与aSAH相关的头痛有关.
中间脑膜动脉 (MMA) 提供了一个潜在的途径,用于针对性治疗干预.

研究的目的:

通过MMA在动脉瘤栓塞过程中通过MMA或不含德克萨米他的长时间输注利多卡因的疗效.
评估这种输液对降低aSAH患者头痛严重程度和阿片类药物需求的影响.

主要方法:

进行了一项前性研究,涉及9名aSAH患者 (亨特和赫斯等级1-2,VAS得分≥7).
患者被随机分为三个组:利多卡因+德克萨米他 (L+D),仅利多卡因 (L),或控制 (没有输液).
在栓塞过程中注射MMA,在多个时间点监测疼痛 (VAS) 和阿片类药物使用 (OME).

主要成果:

与对照组 (14%) 相比,L+D组的VAS得分显著下降 (75%下降).
无论是L+D和L组,都显示了疼痛负担和累积阿片类药物消费 (OME) 的大幅降低.
没有报告任何并发症,这表明MMA输注的安全性概况有利.

结论:

用利多卡因±德克萨米他输入中脑膜动脉是一种安全和潜在的有效方法来管理aSAH相关的头痛.
这种方法可以提供持续的阿片类药物节约性疼痛缓解.
需要进一步的大规模研究来验证这些发现并完善治疗方案.

关键词:

动脉瘤是一个动脉瘤.脑下关节下出血脑下关节下出血

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