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蛛网膜下腔出血的诊断与治疗。

Diagnosis and management of subarachnoid haemorrhage.

机构信息

University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2GW, UK.

Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.

出版信息

Nat Commun. 2024 Feb 29;15(1):1850. doi: 10.1038/s41467-024-46015-2.

Abstract

Aneurysmal subarachnoid haemorrhage (aSAH) presents a challenge to clinicians because of its multisystem effects. Advancements in computed tomography (CT), endovascular treatments, and neurocritical care have contributed to declining mortality rates. The critical care of aSAH prioritises cerebral perfusion, early aneurysm securement, and the prevention of secondary brain injury and systemic complications. Early interventions to mitigate cardiopulmonary complications, dyselectrolytemia and treatment of culprit aneurysm require a multidisciplinary approach. Standardised neurological assessments, transcranial doppler (TCD), and advanced imaging, along with hypertensive and invasive therapies, are vital in reducing delayed cerebral ischemia and poor outcomes. Health care disparities, particularly in the resource allocation for SAH treatment, affect outcomes significantly, with telemedicine and novel technologies proposed to address this health inequalities. This article underscores the necessity for comprehensive multidisciplinary care and the urgent need for large-scale studies to validate standardised treatment protocols for improved SAH outcomes.

摘要

颅内动脉瘤性蛛网膜下腔出血(aSAH)因其多系统影响而对临床医生构成挑战。计算机断层扫描(CT)、血管内治疗和神经重症监护方面的进步有助于降低死亡率。aSAH 的重症监护重点在于脑灌注、早期动脉瘤固定以及预防继发性脑损伤和全身并发症。为了减轻心肺并发症、电解质紊乱和治疗责任动脉瘤,需要采用多学科方法进行早期干预。标准化的神经学评估、经颅多普勒(TCD)和高级成像,以及高血压和有创治疗,对于减少迟发性脑缺血和不良预后至关重要。医疗保健差距,特别是在 SAH 治疗资源分配方面,对结果有重大影响,有人提议采用远程医疗和新技术来解决这些健康不平等问题。本文强调了全面多学科护理的必要性,以及迫切需要进行大规模研究来验证标准化治疗方案,以改善 SAH 结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e7c/10904840/259fc6bdd011/41467_2024_46015_Fig1_HTML.jpg

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