Onichimowski Dariusz, Nosek Krzysztof, Goraj Radosław, Jalali Rakesh, Wińska Aleksandra, Pawlos Aleksandra, Tuyakov Bułat
Department of Anesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
Department of Neurology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
Drug Des Devel Ther. 2018 Jun 20;12:1777-1783. doi: 10.2147/DDDT.S158237. eCollection 2018.
Despite the progress in the management of cerebral arterial aneurysms, subarachnoid hemorrhage (SAH) remains the major cause of neurological disability. While SAH-related deaths usually occur as a result of brain impairment due to hemorrhage, permanent neurological deficits are caused by cerebral ischemia due to edema and spasm of cerebral arteries. Additionally, ~20%-30% of patients with SAH develop secondary cardiomyopathy; this phenomenon is known as neurogenic stress cardiomyopathy (NSC), which is associated with increased mortality and poor long-term prognosis. Levosimendan is a new inotropic drug that causes calcium sensitization of troponin C, thus increasing contraction force of myofilaments. The drug also causes opening of ATP-dependent potassium channels in vascular smooth muscles, which results in dilatation of veins and arteries, including cerebral arteries. To date, there have been several reports of levosimendan application in patients with SAH and neurogenic stress cardiomyopathy, and the effect of the drug on vasospasm has been previously advocated. This paper presents a case report of a 57-year-old patient with massive SAH, where levosimendan was used for reducing vasospasm.
尽管在脑动脉瘤的治疗方面取得了进展，但蛛网膜下腔出血（SAH）仍然是导致神经功能残疾的主要原因。SAH相关的死亡通常是由于出血导致的脑损伤，而永久性神经功能缺损则是由脑动脉水肿和痉挛引起的脑缺血所致。此外，约20%-30%的SAH患者会发展为继发性心肌病；这种现象被称为神经源性应激性心肌病（NSC），它与死亡率增加和长期预后不良有关。左西孟旦是一种新型的强心药物，它能使肌钙蛋白C钙敏化，从而增加肌丝的收缩力。该药物还能使血管平滑肌中的ATP依赖性钾通道开放，导致静脉和动脉扩张，包括脑动脉。迄今为止，已有多篇关于左西孟旦应用于SAH和神经源性应激性心肌病患者的报道，并且该药物对血管痉挛的作用此前也得到了提倡。本文介绍了一名57岁大量SAH患者的病例报告，该患者使用左西孟旦来减轻血管痉挛。
