Chimowitz M I, Pessin M S
Department of Neurology, New England Medical Center, Boston, MA 02111.
Stroke. 1987 Nov-Dec;18(6):1169-72. doi: 10.1161/01.str.18.6.1169.
Proven effective therapy to prevent ischemic deficits and other complications after subarachnoid hemorrhage is lacking despite extensive research efforts. A literature review documented both clinical and experimental evidence suggesting that heparin may be effective in preventing ischemic deficits after subarachnoid hemorrhage by reversing vasospasm, improving blood flow through narrowed vessels, and preventing the development of a proliferative angiopathy. Additional evidence suggests that heparinization of the cerebrospinal fluid following subarachnoid hemorrhage may prevent the development of hydrocephalus. In the only clinical trial using heparin after subarachnoid hemorrhage, the incidence of rebleeding in the heparinized patients was no higher than in the control group. We conclude that the existing preliminary data concerning a role for heparin in the management of the complications of subarachnoid hemorrhage is promising, but further controlled studies are needed prior to clinical application.
尽管进行了广泛的研究，但仍缺乏经证实有效的预防蛛网膜下腔出血后缺血性缺陷和其他并发症的治疗方法。一项文献综述记录了临床和实验证据，表明肝素可能通过逆转血管痉挛、改善通过狭窄血管的血流以及预防增殖性血管病的发展，有效预防蛛网膜下腔出血后的缺血性缺陷。其他证据表明，蛛网膜下腔出血后脑脊液肝素化可能预防脑积水的发生。在唯一一项蛛网膜下腔出血后使用肝素的临床试验中，肝素化患者的再出血发生率并不高于对照组。我们得出结论，关于肝素在蛛网膜下腔出血并发症管理中作用的现有初步数据很有前景，但在临床应用之前还需要进一步的对照研究。
