Bell T E, Kongable G L
Stanford University Medical Center, California 94305, USA.
J Neurosci Nurs. 1996 Apr;28(2):107-13. doi: 10.1097/01376517-199604000-00008.
Aneurysmal subarachnoid hemorrhage (SAH) affects approximately 30,000 people each year in North America. At least 30% of these patients will develop vasospasm as a result of the initial hemorrhage, and two thirds of these develop permanent disabilities or die. Blood deposited into the basal cisterns from the ruptured aneurysm can form thick clots around the major cerebral vessels. The by-products of the hemolyzed clots are believed to be responsible for the subsequent development of vasospasm. Hypervolemic, hypertensive, hemodilution therapy (HHHT) and nimodipine may improve outcome in some cases but there is no therapy known to prevent vasospasm in all patients. One potential therapeutic agent under investigation is tissue plasminogen activator (t-PA), a fibrinolytic enzyme. Instilled into the basal cisterns at time of aneurysm clipping, t-PA dissolves the clot so spasmogenic substances may be removed, thus preventing or reducing the severity of vasospasm.
在北美，每年约有3万人患动脉瘤性蛛网膜下腔出血（SAH）。这些患者中至少有30%会因初次出血而发生血管痉挛，其中三分之二会出现永久性残疾或死亡。破裂动脉瘤流入脑基底池的血液可在大脑主要血管周围形成厚厚的凝块。据信，溶血凝块的副产品是随后发生血管痉挛的原因。在某些情况下，高血容量、高血压、血液稀释疗法（HHHT）和尼莫地平可能会改善预后，但目前尚无已知疗法可预防所有患者的血管痉挛。一种正在研究的潜在治疗药物是组织纤溶酶原激活剂（t-PA），一种纤维蛋白溶解酶。在动脉瘤夹闭时注入脑基底池，t-PA可溶解凝块，从而清除致痉挛物质，预防或减轻血管痉挛的严重程度。
