Department of Neurology, Neurosciences Intensive Care Unit, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 428, Charleston, SC 29425, USA.
Neurosurg Clin N Am. 2010 Apr;21(2):353-64. doi: 10.1016/j.nec.2009.10.006.
Vasospasm is a major cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage. This article reviews the risk factors for vasospasm; the various methods for diagnosing vasospasm including the conventional 4-vessel angiography, computed tomographic angiography, and computed tomographic perfusion; the methods to detect vasospasm before clinical onset (including transcranial Doppler ultrasonography); and the recent emergence of multimodality monitoring. A discussion of medical treatment options in the setting of vasospasm is also included; the prophylactic use of "neuroprotectants" such as nimodipine, statins, and magnesium and the role of hemodynamic augmentation in vasospasm amelioration, including the use of inotropic support in addition to traditional triple-H therapy, are discussed.
血管痉挛是蛛网膜下腔出血后发病率和死亡率的主要原因。本文综述了血管痉挛的危险因素；包括常规 4 血管血管造影、计算机断层血管造影和计算机断层灌注在内的各种诊断血管痉挛的方法；在临床发作前检测血管痉挛的方法（包括经颅多普勒超声）；以及最近出现的多模态监测。还讨论了血管痉挛时的治疗选择；预防性使用尼莫地平、他汀类药物和镁等“神经保护剂”，以及在血管痉挛缓解中血流动力学增强的作用，包括除传统的三重 H 治疗外，还使用正性肌力支持。
