Kiser Tyree H
Department of Clinical Pharmacy, University of Colorado School of Pharmacy and Pharmaceutical Sciences, and Critical Care Pharmacy Specialist, University of Colorado Hospital.
Hosp Pharm. 2013 Sep;48(5 Suppl):S2-S9. doi: 10.1310/hpj48S5-S2. Epub 2013 Sep 1.
Cerebral vasospasm and delayed cerebral ischemia continue to be major contributors to morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH).
The purpose of this review was to evaluate the pharmacotherapy interventions for the prevention and management of cerebral vasospasm in patients with SAH.
A search of MEDLINE (January 1966-April 2012) and EMBASE (January 1974-April 2012) was conducted to retrieve relevant studies of pharmacotherapy options for prevention or treatment of cerebral vasospasm in SAH.
Triple-H therapy (hypervolemia, hemodilution, hypertension) has been a widely accepted option by many clinicians for the management of cerebral vasospasm and delayed cerebral ischemia. However, implementation of Triple-H therapy varies considerably at individual institutions. Nimodipine and nicardipine have demonstrated the most dependable improvements in patient outcomes to date. High doses of intravenous magnesium have failed to show consistent benefits. Magnesium supplementation to prevent hypomagnesaemia should be employed. Statin therapy should be continued in patients who are taking statins prior to hospital admission. Use of statins in naive patients may be recommended when the results of an ongoing prospective study are available. Of the available locally administered pharmacologic therapies, nicardipine and thrombolytics appear to provide the most intriguing benefit-to-risk ratio. However, the data supporting the use of locally administered therapy are modest at best and require careful consideration prior to application.
Clinical studies have tested a variety of pharmacotherapy interventions for the prevention and treatment of cerebral vasospasm. Of available therapies, nimodipine has demonstrated consistent benefits and should be employed routinely. Demonstration of reduced cerebral vasospasm and improved neurological outcomes in larger prospective studies are needed for most pharmacologic therapy options prior to recommending their routine use.
脑血管痉挛和迟发性脑缺血仍然是动脉瘤性蛛网膜下腔出血（SAH）后发病和死亡的主要原因。
本综述的目的是评估用于预防和治疗SAH患者脑血管痉挛的药物治疗干预措施。
检索MEDLINE（1966年1月至2012年4月）和EMBASE（1974年1月至2012年4月），以检索有关预防或治疗SAH中脑血管痉挛的药物治疗选择的相关研究。
三联H疗法（扩容、血液稀释、高血压）已被许多临床医生广泛接受，用于治疗脑血管痉挛和迟发性脑缺血。然而，三联H疗法在各个机构的实施差异很大。尼莫地平和尼卡地平迄今为止已显示出对患者预后最可靠的改善。高剂量静脉注射镁未能显示出一致的益处。应采用补充镁以预防低镁血症。入院前正在服用他汀类药物的患者应继续使用他汀类药物治疗。当正在进行的前瞻性研究结果可用时，可能建议在未服用过他汀类药物的患者中使用他汀类药物。在可用的局部给药药物治疗中，尼卡地平和溶栓药物似乎提供了最具吸引力的效益风险比。然而，支持使用局部给药治疗的数据充其量只是适度的，在应用前需要仔细考虑。
临床研究已经测试了多种预防和治疗脑血管痉挛的药物治疗干预措施。在可用的治疗方法中，尼莫地平已显示出一致的益处，应常规使用。在推荐大多数药物治疗方案常规使用之前，需要在更大规模的前瞻性研究中证明其能减少脑血管痉挛并改善神经功能结局。
