动脉瘤性蛛网膜下腔出血后脑血管痉挛的治疗综述
A Review of the Management of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage.
作者信息
Li Kenny, Barras Christen D, Chandra Ronil V, Kok Hong K, Maingard Julian T, Carter Nicole S, Russell Jeremy H, Lai Leon, Brooks Mark, Asadi Hamed
机构信息
School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
University of Adelaide, North Terrace Campus, Adelaide, South Australia, Australia; South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
出版信息
World Neurosurg. 2019 Jun;126:513-527. doi: 10.1016/j.wneu.2019.03.083. Epub 2019 Mar 18.
BACKGROUND
Despite decades of research, cerebral vasospasm (CV) continues to account for high morbidity and mortality in patients who survive their initial aneurysmal subarachnoid hemorrhage.
OBJECTIVE
To define the scope of the problem and review key treatment strategies that have shaped the way CV is managed in the contemporary era.
METHODS
A literature search was performed of CV management after aneurysmal subarachnoid hemorrhage.
RESULTS
Recent advances in neuroimaging have led to improved detection of vasospasm, but established treatment guidelines including hemodynamic augmentation and interventional procedures remain highly variable among neurosurgical centers. Experimental research in subarachnoid hemorrhage continues to identify novel targets for therapy.
CONCLUSIONS
Proactive and preventive strategies such as oral nimodipine and endovascular rescue therapies can reduce the morbidity and mortality associated with CV.
背景
尽管经过数十年的研究，但在初次动脉瘤性蛛网膜下腔出血后存活的患者中，脑血管痉挛（CV）仍然是高发病率和高死亡率的原因。
目的
确定该问题的范围，并回顾在当代影响CV治疗方式的关键治疗策略。
方法
对动脉瘤性蛛网膜下腔出血后的CV治疗进行文献检索。
结果
神经影像学的最新进展提高了对血管痉挛的检测，但包括血流动力学增强和介入手术在内的既定治疗指南在神经外科中心之间仍存在很大差异。蛛网膜下腔出血的实验研究继续确定新的治疗靶点。
结论
口服尼莫地平和血管内抢救治疗等积极的预防策略可以降低与CV相关的发病率和死亡率。
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