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血管痉挛治疗与预防的进展

Advances in vasospasm treatment and prevention.

作者信息

Komotar Ricardo J, Zacharia Brad E, Valhora Ricky, Mocco J, Connolly E Sander

机构信息

Department of Neurosurgery, Columbia University, New York, NY, USA.

出版信息

J Neurol Sci. 2007 Oct 15;261(1-2):134-42. doi: 10.1016/j.jns.2007.04.046. Epub 2007 Jun 13.

Abstract

Outcome after aSAH depends on several factors, including the severity of the initial event, perioperative medical management, surgical variables, and the incidence of complications. Cerebral vasospasm (CV) is ure to consistently respond to treatment, emphasizing the need for further research into the underlying mechanisms of SAH-induced cerebrovascular dysfunction. To this end, our paper reviews the relevant literature on the main therapies employed for CV after aSAH and discusses possible avenues for future investigations. Current management of this condition consists of maximal medical therapy, including triple H regimen and oral administration of calcium antagonists, followed by endovascular balloon angioplasty and/or injection of vasodilatory agents for refractory cases. As the precise pathophysiology of CV is further elucidated, the development of promising investigational therapies will follow.

摘要

动脉瘤性蛛网膜下腔出血(aSAH)后的预后取决于多个因素,包括初始事件的严重程度、围手术期的医疗管理、手术变量以及并发症的发生率。脑血管痉挛(CV)一直难以对治疗产生持续反应,这凸显了对SAH诱发的脑血管功能障碍潜在机制进行进一步研究的必要性。为此,我们的论文回顾了aSAH后用于CV的主要治疗方法的相关文献,并讨论了未来研究的可能途径。目前对这种情况的管理包括最大限度的药物治疗,包括三联H疗法和口服钙拮抗剂,对于难治性病例则采用血管内球囊血管成形术和/或注射血管扩张剂。随着CV确切病理生理学的进一步阐明,有望出现有前景的研究性治疗方法。

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