Objective@#To investigate the effect of
nimodipine combined with
cerebrospinal fluid replacement on
hemoglobin concentration,
Toll-like receptor 4 (TLR4) expression level and
cerebral vasospasm (CVS) in
patients with CVS after
aneurysmal subarachnoid hemorrhage (aSAH).@*
Methods @#One hundred and twenty
patients with CVS after aSAH admitted to the Department of
Neurosurgery , the Sixth Medical Center of PLA
General Hospital from May 2013 to May 2015 were selected. They were randomly divided into
control group and
observation group (n=60 in each group). The
control group received conventional
treatment and
nimodipine infusion after embolization of the
aneurysms , and the
observation group underwent
cerebrospinal fluid replacement by
lumbar puncture on this basis. The
clinical efficacy ,
Glasgow Coma Scale (GCS) scores,
hemoglobin concentration and TLR4 expression levels before and
after treatment , and adverse reactions were compared between the two groups.@*Results@#One month
after treatment , the improvement rate of vasospasm in the
observation group was significantly higher than that in the
control group (86.7% vs. 60.0%; χ2=9.590, P=0.002). Three months after the
treatment , the good rate of clinical outcome (the modified Rankin Scale score 0-2) was significantly higher than that of the
control group (88.3% vs. 58.3%; χ2 =13.807, P<0.001). Before
treatment , there were no significant differences in
hemoglobin concentration and TLR4 expression levels between the two groups;
after treatment , the
hemoglobin concentration and TLR4 expression levels of both groups were significantly reduced (P<0.05). Compared with the
control group , the
hemoglobin concentration (119.9±19.8 g/L vs. 137.6±17.8 g/L; t=3.270, P=0.001) and TLR4 expression level (2.5±1.2 vs. 4.5±1.5; t=8.060, P<0.001) in the
observation group decreased more significantly. Multivariate
logistic regression analysis showed that
hypertension (
odds ratio [OR] 5.19, 95%
confidence interval [CI] 2.31-6.71),
hyperlipidemia (OR 2.70, 95% CI 1.93-4.86), previous
history of
stroke or
transient ischemic attack (OR 6.29, 95% CI 3.23-7.32),
smoking (OR 4.80, 95% CI 2.18-6.19), and the TLR4 expression level before
treatment (OR 3.28, 95% CI 2.87-6.93) were independently correlated with the lack of improvement in CVS, and
cerebrospinal fluid replacement was independently correlated with CVS improvement (OR 0.40, 95% CI 0.14-0.89). There was no significant difference in the
incidence of adverse reactions such as
blood pressure drop,
obstructive hydrocephalus and
gastrointestinal hemorrhage between the
observation group and the
control group , but the
incidence of delayed CVS (13.3% vs. 36.7%; χ2=7.510, P=0.006) and
secondary cerebral infarction (8.3% vs. 31.7%; χ2=8.800, P=0.003) in the
observation group were significantly lower than those of the
observation group.@*Conclusion@#
Nimodipine infusion combined with
cerebrospinal fluid replacement by
lumbar puncture affected the
hemoglobin concentration and TLR4 expression levels, improved the CVS improvement rate, and significantly improved the clinical outcome in
patients with CVS after aSAH.