Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick.
Departments of 2 Neurosurgery.
Neurosurg Focus. 2017 Nov;43(5):E14. doi: 10.3171/2017.8.FOCUS17431.
OBJECTIVE Little is known regarding the natural history of posttraumatic vasospasm. The authors review the pathophysiology of posttraumatic vasospasm (PTV), its associated risk factors, the efficacy of the technologies used to detect PTV, and the management/treatment options available today. METHODS The authors performed a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following databases: PubMed, Google Scholar, and CENTRAL (the Cochrane Central Register of Controlled Trials). Outcome variables extracted from each study included epidemiology, pathophysiology, time course, predictors of PTV and delayed cerebral ischemia (DCI), optimal means of surveillance and evaluation of PTV, application of multimodality monitoring, modern management and treatment options, and patient outcomes after PTV. Study types were limited to retrospective chart reviews, database reviews, and prospective studies. RESULTS A total of 40 articles were included in the systematic review. In many cases of mild or moderate traumatic brain injury (TBI), imaging or ultrasonographic studies are not performed. The lack of widespread assessment makes finding the true overall incidence of PTV a difficult endeavor. The clinical consequences of PTV are important, given the morbidity that can result from it. DCI manifests as new-onset neurological deterioration that occurs beyond the timeframe of initial brain injury. While there are many techniques that attempt to diagnose cerebral vasospasm, digital subtraction angiography is the gold standard. Some predictors of PTV include SAH, intraventricular hemorrhage, low admission Glasgow Coma Scale (GCS) score (< 9), and young age (< 30 years). CONCLUSIONS Given these results, clinicians should suspect PTV in young patients presenting with intracranial hemorrhage (ICH), especially SAH and/or intraventricular hemorrhage, who present with a GCS score less than 9. Monitoring and regulation of CNS metabolism following TBI/ICH-induced vasospasm may play an important adjunct role to the primary prevention of vasospasm.
关于创伤后血管痉挛的自然病程知之甚少。作者回顾了创伤后血管痉挛（PTV）的病理生理学、相关危险因素、用于检测 PTV 的技术的疗效，以及目前可用的治疗/处理选择。
作者根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行了系统评价，使用了以下数据库：PubMed、Google Scholar 和 CENTRAL（Cochrane 对照试验中心注册库）。从每项研究中提取的结果变量包括流行病学、病理生理学、时间进程、PTV 和迟发性脑缺血（DCI）的预测因素、PTV 的最佳监测和评估方法、多模态监测的应用、现代管理和治疗选择，以及 PTV 后的患者结局。研究类型限于回顾性图表审查、数据库审查和前瞻性研究。
系统评价共纳入 40 篇文章。在许多轻度或中度创伤性脑损伤（TBI）的情况下，不进行影像学或超声检查。缺乏广泛的评估使得发现 PTV 的真实总体发生率变得困难。PTV 的临床后果很重要，因为由此产生的发病率很高。DCI 表现为初始脑损伤时间范围之外出现的新发神经功能恶化。虽然有许多技术试图诊断脑血管痉挛，但数字减影血管造影是金标准。PTV 的一些预测因素包括蛛网膜下腔出血、脑室内出血、入院格拉斯哥昏迷量表（GCS）评分低（<9）和年龄较小（<30 岁）。
鉴于这些结果，对于出现颅内出血（ICH）的年轻患者，尤其是蛛网膜下腔出血和/或脑室内出血且 GCS 评分<9 的患者，临床医生应怀疑存在 PTV。TBI/ICH 引起的血管痉挛后监测和调节中枢神经系统代谢可能对血管痉挛的一级预防起到重要的辅助作用。
