Wartenberg Katja E, Mayer Stephan A
Neurological Intensive Care Unit, Columbia-Presbyterian Medical Center, New York 10032, USA.
Curr Opin Crit Care. 2006 Apr;12(2):78-84. doi: 10.1097/01.ccx.0000216571.80944.65.
To summarize new concepts regarding the occurrence, prevention, and management of medical complications following subarachnoid hemorrhage.
Data regarding the impact of common medical complications after subarachnoid hemorrhage on delayed cerebral ischemia and neurological outcome after subarachnoid hemorrhage are available from recent outcomes studies. Fever, anemia requiring transfusion, hyperglycemia, electrolyte abnormalities, pneumonia, hypertension, and neurogenic stunned myocardium and pulmonary edema occur frequently after subarachnoid hemorrhage. Fever, anemia, hyperglycemia, and acute hypoxia and hypotension related to neurogenic stunned myocardium have the greatest impact on mortality and functional outcome after subarachnoid hemorrhage. Potential treatment interventions for these complications include the development of acute resuscitation strategies to optimize cerebral perfusion in poor-grade patients, maintaining normothermia with systemic cooling devices, administration of erythropoietin to prevent severe anemia, preserving normoglycemia with continuous insulin infusions, and goal-directed hemodynamic support guided by brain tissue oxygenation.
Clinical trials to investigate interventions targeted at preventing or treating common medical complications after subarachnoid hemorrhage are needed.
总结蛛网膜下腔出血后医学并发症的发生、预防及管理方面的新概念。
近期的结局研究提供了有关蛛网膜下腔出血后常见医学并发症对迟发性脑缺血及蛛网膜下腔出血后神经功能结局影响的数据。蛛网膜下腔出血后常出现发热、需输血的贫血、高血糖、电解质异常、肺炎、高血压以及神经源性休克心肌和肺水肿。发热、贫血、高血糖以及与神经源性休克心肌相关的急性缺氧和低血压对蛛网膜下腔出血后的死亡率和功能结局影响最大。针对这些并发症的潜在治疗干预措施包括制定急性复苏策略以优化病情较差患者的脑灌注、使用全身冷却装置维持正常体温、给予促红细胞生成素预防严重贫血、持续输注胰岛素维持正常血糖水平以及以脑组织氧合为指导进行目标导向的血流动力学支持。
需要开展临床试验来研究针对预防或治疗蛛网膜下腔出血后常见医学并发症的干预措施。
