Roh David J, Morris Nicholas A, Claassen Jan
Department of Neurology, Division of Critical Care and Hospitalist Neurology, Columbia University, New York, New York, U.S.A.
J Clin Neurophysiol. 2016 Jun;33(3):241-9. doi: 10.1097/WNP.0000000000000277.
Management of patients with aneurysmal subarachnoid hemorrhage focuses on prevention of rebleeding by early treatment of the aneurysm, as well as detection and management of neurologic and medical complications. Early detection of delayed cerebral ischemia and management of modifiable contributing causes such as vasospasm take a central role, with the goal of preventing irreversible cerebral injury. In efforts to prevent delayed cerebral ischemia, multimodality monitoring has emerged as a promising tool in detecting subclinical physiologic changes before infarction occurs. However, there has been much variability in the utilization of this technology. Recent consensus guidelines discuss the role of multimodality monitoring in acute brain injury. In this review, we evaluate these guidelines and the utility of each modality of multimodality monitoring in aneurysmal subarachnoid hemorrhage.
动脉瘤性蛛网膜下腔出血患者的管理重点在于通过早期治疗动脉瘤来预防再出血，以及检测和处理神经及内科并发症。早期发现延迟性脑缺血并处理可改变的促成因素（如血管痉挛）起着核心作用，目标是预防不可逆的脑损伤。为预防延迟性脑缺血，多模态监测已成为在梗死发生前检测亚临床生理变化的一种有前景的工具。然而，这项技术的应用存在很大差异。最近的共识指南讨论了多模态监测在急性脑损伤中的作用。在本综述中，我们评估这些指南以及多模态监测的每种模式在动脉瘤性蛛网膜下腔出血中的效用。
