Yale University Department of Anesthesiology, New Haven, Connecticut, USA.
Curr Opin Anaesthesiol. 2011 Oct;24(5):500-7. doi: 10.1097/ACO.0b013e32834ad45b.
Aneurysmal subarachnoid hemorrhage (SAH) remains a devastating condition with high mortality and poor outcome among survivors. Early surgical or endovascular securing of the aneurysm is the norm, and management of these patients is precarious due to their unstable intracranial physiology and the severe systemic medical complications common in SAH.
New research into biomarkers and clinical factors with their association to outcome in SAH can help us to identify patients at risk. New evidence questions the benefit of broad application of the current SAH treatment mainstays, and re-examines agents previously failing clinical trials.
Growing knowledge of the physiologic derangements associated with poor outcomes in SAH can improve our understanding of the widespread physiologic changes occurring with SAH and with further research, may provide clinicians with a direction for increasingly meaningful intervention. Ongoing investigation of our current therapeutics enable clinicians to apply them more judiciously to suitable patients, thereby enhancing the benefit and minimizing the complications of such treatments. Furthermore, by re-evaluating previously disproved treatments through the use of novel regimens or administration routes, promising treatment options are emerging.
尽管动脉瘤性蛛网膜下腔出血（SAH）患者的死亡率仍然很高，幸存者预后不良，但目前仍是一种极具破坏性的疾病。通常会对患者进行早期的手术或血管内夹闭动脉瘤，以确保其安全，但由于患者颅内生理学不稳定，以及 SAH 常见的严重全身性医疗并发症，这些患者的管理仍具有挑战性。
对与 SAH 预后相关的生物标志物和临床因素的新研究，有助于我们识别风险患者。新证据对广泛应用当前 SAH 治疗主要方法的益处提出了质疑，并重新审视了以前临床试验失败的药物。
对与 SAH 不良预后相关的生理紊乱的认识不断增加，可以提高我们对 SAH 及广泛发生的生理变化的理解，进一步的研究可能为临床医生提供更有意义的干预方向。对当前治疗方法的持续研究使临床医生能够更明智地将其应用于合适的患者，从而提高治疗效果并最大程度地减少此类治疗的并发症。此外，通过使用新方案或给药途径重新评估以前被否定的治疗方法，出现了有希望的治疗选择。
