Lo Benjamin W Y, Fukuda Hitoshi, Nishimura Yusuke, Macdonald R Loch, Farrokhyar Forough, Thabane Lehana, Levine Mitchell A H
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
Department of Neurosurgery, Kurashiki Central Hospital, University of Kyoto, Okayama, Japan.
Surg Neurol Int. 2015 Aug 11;6:136. doi: 10.4103/2152-7806.162677. eCollection 2015.
Patients with ruptured brain aneurysms and aneurysmal subarachnoid hemorrhage suffer neurological damage from primary injury of the aneurysm rupture itself, as well as a number of secondary injurious processes that can further worsen the affected individual's neurological state. In addition, other body systems can be affected in a number of brain-body associations.
This systematic review synthesizes prospective and retrospective cohort studies that investigate brain-body associations in patients with ruptured brain aneurysms. The methodologic quality of these studies will be appraised.
Six cohort studies were included in this systemic review. The methodologic quality of each study was assessed. They had representative patient populations, clear selection criteria and clear descriptions of study designs. Reproducible study protocols with ethics board approval were present. Clinical results were described in sufficient detail and were applicable to aneurysmal subarachnoid hemorrhage patients in clinical practice. There were few withdrawals from the study. Limitations included small sample sizes and between-study differences in diagnostic tests and clinical outcome endpoints. Several pathophysiologic mechanisms of brain-body associations in ruptured brain aneurysms were clarified through this systematic review. Sympathetic activation of the cardiovascular system in aneurysmal subarachnoid hemorrhage not only triggers the release of atrial and brain natriuretic peptides it can also lead to increased pulmonary venous pressures and permeability causing hydrostatic pulmonary edema. Natriuretic states can herald the onset or worsening of clinical vasospasm as the renin-angiotensin-aldosterone system is activated in a delayed manner.
This systematic review synthesizes the most current evidence of underlying mechanisms of brain related associations with body systems in aneurysmal subarachnoid hemorrhage. Results gained from these studies are clinically useful and shed light on how ruptured brain aneurysms affect the cardiopulmonary system. Subsequent neuro-cardio-endocrine responses then interact with other body systems as part of the secondary responses to primary injury.
脑动脉瘤破裂和动脉瘤性蛛网膜下腔出血患者会因动脉瘤破裂本身的原发性损伤以及一些继发性损伤过程而遭受神经损伤，这些继发性损伤过程会进一步恶化患者的神经状态。此外，在许多脑-体关联中，其他身体系统也可能受到影响。
本系统评价综合了前瞻性和回顾性队列研究，这些研究调查了脑动脉瘤破裂患者的脑-体关联。将对这些研究的方法学质量进行评估。
本系统评价纳入了6项队列研究。评估了每项研究的方法学质量。它们具有代表性的患者群体、明确的选择标准和对研究设计的清晰描述。有经伦理委员会批准的可重复研究方案。临床结果描述详细，适用于临床实践中的动脉瘤性蛛网膜下腔出血患者。研究中的退出情况很少。局限性包括样本量小以及研究之间在诊断测试和临床结局终点方面存在差异。通过本系统评价阐明了脑动脉瘤破裂后脑-体关联的几种病理生理机制。动脉瘤性蛛网膜下腔出血时心血管系统的交感神经激活不仅会触发心房利钠肽和脑利钠肽的释放，还会导致肺静脉压力和通透性增加，从而引起静水压性肺水肿。随着肾素-血管紧张素-醛固酮系统延迟激活，利钠状态可预示临床血管痉挛的发作或恶化。
本系统评价综合了动脉瘤性蛛网膜下腔出血中脑与身体系统相关潜在机制的最新证据。这些研究获得的结果在临床上有用，并阐明了破裂的脑动脉瘤如何影响心肺系统。随后的神经-心脏-内分泌反应作为对原发性损伤的继发性反应的一部分，然后与其他身体系统相互作用。
