Findlay J Max, Nisar Joshua, Darsaut Tim
University of Alberta Hospital - Medicine,Edmonton,Alberta,Canada.
Can J Neurol Sci. 2016 Jan;43(1):15-32. doi: 10.1017/cjn.2015.288. Epub 2015 Sep 2.
Cerebral vasospasm is a prolonged but reversible narrowing of cerebral arteries beginning days after subarachnoid hemorrhage. Progression to cerebral ischemia is tied mostly to vasospasm severity, and its pathogenesis lies in artery encasement by blood clot, although the complex interactions between hematoma and surrounding structures are not fully understood. The delayed onset of vasospasm provides a potential opportunity for its prevention. It is disappointing that recent randomized, controlled trials did not demonstrate that the endothelin antagonist clazosentan, the cholesterol-lowering agent simvastatin, and the vasodilator magnesium sulfate improve patient outcome. Minimizing ischemia by avoiding inadequate blood volume and pressure, administering the calcium antagonist nimodipine, and intervention with balloon angioplasty, when necessary, constitutes current best management. Over the past two decades, our ability to manage vasospasm has led to a significant decline in patient morbidity and mortality from vasospasm, yet it still remains an important determinant of outcome after aneurysm rupture.
脑血管痉挛是蛛网膜下腔出血数天后开始出现的脑动脉的持续但可逆的狭窄。进展为脑缺血主要与血管痉挛的严重程度相关，其发病机制在于血凝块对动脉的包裹，尽管血肿与周围结构之间的复杂相互作用尚未完全明确。血管痉挛的延迟发作提供了预防的潜在机会。令人失望的是，最近的随机对照试验并未证明内皮素拮抗剂氯沙坦、降胆固醇药物辛伐他汀和血管扩张剂硫酸镁能改善患者预后。通过避免血容量和血压不足、给予钙拮抗剂尼莫地平以及必要时进行球囊血管成形术干预来尽量减少缺血，构成了目前的最佳治疗方法。在过去二十年中，我们管理血管痉挛的能力已使因血管痉挛导致的患者发病率和死亡率显著下降，但它仍然是动脉瘤破裂后预后的重要决定因素。
