Smith Martin
National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.
Curr Opin Anaesthesiol. 2007 Oct;20(5):400-7. doi: 10.1097/ACO.0b013e3282efa686.
The aim of this article is to summarize recent concepts regarding the intensive care management of patients with subarachnoid haemorrhage, emphasizing the detection and treatment of cerebral vasospasm and the management of systemic complications.
Aneurysmal subarachnoid haemorrhage is a potentially devastating disease that requires complex treatment strategies and extended monitoring. The prognosis of subarachnoid haemorrhage depends on the severity of the initial bleed, the success of the procedure to secure the aneurysm and the occurrence and severity of sequelae, including cerebral vasospasm. Patients with subarachnoid haemorrhage benefit from multidisciplinary neurointensive care where management is targeted at securing the ruptured aneurysm, optimizing cardiovascular variables, detecting and treating cerebral vasospasm and managing systemic complications.
The complex treatment strategies applied after subarachnoid haemorrhage call for interdisciplinary collaboration between neurosurgeons, neuroradiologists, neurointensivists and specialist nurses. Specialized neuromonitoring and neuroimaging techniques must also be available. The neurointensive care unit serves as the focal point for these combined efforts.
本文旨在总结蛛网膜下腔出血患者重症监护管理的最新概念，重点强调脑血管痉挛的检测与治疗以及全身并发症的管理。
动脉瘤性蛛网膜下腔出血是一种潜在的毁灭性疾病，需要复杂的治疗策略和长期监测。蛛网膜下腔出血的预后取决于初始出血的严重程度、动脉瘤夹闭手术的成功率以及后遗症（包括脑血管痉挛）的发生情况和严重程度。蛛网膜下腔出血患者受益于多学科神经重症监护，其管理目标是夹闭破裂的动脉瘤、优化心血管变量、检测和治疗脑血管痉挛以及管理全身并发症。
蛛网膜下腔出血后应用的复杂治疗策略需要神经外科医生、神经放射科医生、神经重症监护医生和专科护士之间的跨学科协作。还必须具备专门的神经监测和神经成像技术。神经重症监护病房是这些联合努力的核心。
