Stevens Robert D, Nyquist Paul A
Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Neurol Sci. 2007 Oct 15;261(1-2):143-56. doi: 10.1016/j.jns.2007.04.047. Epub 2007 Jun 4.
Aneurysmal subarachnoid hemorrhage (SAH) is analogous to a pathophysiological watershed, disrupting brain integrity and function and precipitating an array of systemic derangements including cardiovascular, respiratory, endocrine, hematological, and immune dysfunction. Extracerebral organ dysfunction is closely linked to the magnitude of the primary neurological insult, suggesting neurogenic, neuroendocrine and neuroimmunomodulatory mechanisms. Systemic organ involvement is associated with increased mortality and neurological impairment, even after adjustment for other outcome predictors such as the severity of the initial neurological injury. This may be a reflection of secondary brain injury precipitated by hypoxemia, circulatory failure, fever, or hyperglycemia, all of which have been linked to adverse clinical outcomes. Interventions to avert or reverse these and other perturbations need to be tested in clinical trials as they represent opportunities to improve survival and neurological recovery in patients with SAH.
动脉瘤性蛛网膜下腔出血（SAH）类似于一种病理生理分水岭，破坏脑完整性和功能，并引发一系列全身紊乱，包括心血管、呼吸、内分泌、血液和免疫功能障碍。脑外器官功能障碍与原发性神经损伤的严重程度密切相关，提示存在神经源性、神经内分泌和神经免疫调节机制。即使在对其他预后预测因素（如初始神经损伤的严重程度）进行调整后，全身器官受累仍与死亡率增加和神经功能损害相关。这可能反映了由低氧血症、循环衰竭、发热或高血糖引发的继发性脑损伤，所有这些都与不良临床结局有关。避免或逆转这些及其他紊乱的干预措施需要在临床试验中进行测试，因为它们代表了改善SAH患者生存率和神经功能恢复的机会。
