蛛网膜下腔出血后难治性血管痉挛的抢救治疗。
Rescue therapy for refractory vasospasm after subarachnoid hemorrhage.
作者信息
Durrant Julia C, Hinson Holly E
机构信息
Department of Neurology and Neurocritical Care, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, CR-127, Portland, OR, 97239, USA,
出版信息
Curr Neurol Neurosci Rep. 2015;15(2):521. doi: 10.1007/s11910-014-0521-1.
Abstract
Vasospasm and delayed cerebral ischemia remain to be the common causes of increased morbidity and mortality after aneurysmal subarachnoid hemorrhage. The majority of clinical vasospasm responds to hemodynamic augmentation and direct vascular intervention; however, a percentage of patients continue to have symptoms and neurological decline. Despite suboptimal evidence, clinicians have several options in treating refractory vasospasm in aneurysmal subarachnoid hemorrhage (aSAH), including cerebral blood flow enhancement, intra-arterial manipulations, and intra-arterial and intrathecal infusions. This review addresses standard treatments as well as emerging novel therapies aimed at improving cerebral perfusion and ameliorating the neurologic deterioration associated with vasospasm and delayed cerebral ischemia.
摘要
血管痉挛和迟发性脑缺血仍然是动脉瘤性蛛网膜下腔出血后发病率和死亡率增加的常见原因。大多数临床血管痉挛对血流动力学增强和直接血管干预有反应；然而，有一定比例的患者仍有症状和神经功能衰退。尽管证据不充分，但临床医生在治疗动脉瘤性蛛网膜下腔出血（aSAH）中的难治性血管痉挛时有多种选择，包括增强脑血流量、动脉内操作以及动脉内和鞘内输注。本文综述了旨在改善脑灌注以及缓解与血管痉挛和迟发性脑缺血相关的神经功能恶化的标准治疗方法和新兴的新疗法。
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