Seule Martin, Muroi Carl, Sikorski Christopher, Keller Emanuela
Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
Acta Neurochir Suppl. 2013;115:57-61. doi: 10.1007/978-3-7091-1192-5_13.
One of the major goals in the treatment of patients with aneurysmal subarachnoid hemorrhage (aSAH) is early detection and treatment of delayed ischemic neurologic deficits (DINDs) to prevent cerebral infarction and thus poor outcome or even death. The complex changes of cerebral metabolism, hemodynamics, and oxygenation after SAH are underestimated if they are considered exclusively based on angiographic cerebral vasospasm (CVS). The discrepancies on one hand may arise from the heterogeneous and complex pathophysiology of DINDs. On the other hand, the occurrence of DINDs may depend on the relationship between local cerebral oxygen delivery and demand, which can only be determined if cerebral blood flow (CBF) and the cerebral metabolic rate of oxygen (CMRO(2)) can be measured. We briefly review the most relevant methods for monitoring cerebral hemodynamics and oxygenation and discuss the limitations associated with early diagnosis of DINDs in patients with severe aSAH not amenable for clinical neurological examination.
动脉瘤性蛛网膜下腔出血（aSAH）患者治疗的主要目标之一是早期发现并治疗延迟性缺血性神经功能缺损（DINDs），以预防脑梗死，从而避免不良后果甚至死亡。如果仅基于血管造影显示的脑血管痉挛（CVS）来考虑，SAH后脑代谢、血流动力学和氧合的复杂变化就会被低估。一方面，差异可能源于DINDs异质性和复杂的病理生理学。另一方面，DINDs的发生可能取决于局部脑氧输送与需求之间的关系，而只有在能够测量脑血流量（CBF）和脑氧代谢率（CMRO₂）时才能确定这种关系。我们简要回顾监测脑血流动力学和氧合的最相关方法，并讨论在无法进行临床神经学检查的重症aSAH患者中早期诊断DINDs的相关局限性。
