Kaptain G J, Lanzino G, Kassell N F
Department of Neurosurgery, Derriford Hospital, Plymouth, England.
Drugs Aging. 2000 Sep;17(3):183-99. doi: 10.2165/00002512-200017030-00003.
The present review focuses on subarachnoid haemorrhage (SAH) secondary to the rupture of an intracranial aneurysm, a condition with a high case fatality rate. Additionally, many of the surviving patients are left with significant disabilities. Risk factors for aneurysmal SAH include both genetic and acquired conditions. The most common presenting symptom is sudden onset of severe headache. Since headache is very common in the general population, it is not unusual that SAH is misdiagnosed at its onset with often catastrophic consequences. Unlike other acute neurological disorders such as brain injury, in which patient outcome is closely related to the extent of the injury occurring at the time of the trauma, patients with aneurysmal SAH are at risk of subsequent deterioration from 'avoidable' complications such as rebleed, vasospasm, hydrocephalus, and several other non-neurological general medical complications. Thus, the critical care management of the patient with SAH is of utmost importance in order to maximise the chances of satisfactory recovery. Although surgical clipping of the ruptured aneurysm remains the gold standard therapy, with the continuing refinement of endovascular techniques, a new, 'less invasive' option is now available, especially for patients considered poor surgical candidates.
本综述聚焦于颅内动脉瘤破裂继发的蛛网膜下腔出血（SAH），这是一种病死率很高的疾病。此外，许多存活患者会留下严重残疾。动脉瘤性SAH的危险因素包括遗传和后天因素。最常见的首发症状是突然发作的剧烈头痛。由于头痛在普通人群中非常常见，SAH在发病时被误诊并不罕见，往往会带来灾难性后果。与其他急性神经系统疾病如脑损伤不同，脑损伤患者的预后与创伤时发生的损伤程度密切相关，而动脉瘤性SAH患者有因“可避免”的并发症（如再出血、血管痉挛、脑积水以及其他几种非神经系统的一般医疗并发症）而随后病情恶化的风险。因此，SAH患者的重症监护管理对于最大限度提高满意康复的机会至关重要。尽管对破裂动脉瘤进行手术夹闭仍然是金标准治疗方法，但随着血管内技术的不断完善，现在有一种新的“侵入性较小”的选择，特别是对于那些被认为不适合手术的患者。
