动脉瘤性蛛网膜下腔出血的反思  

Introspection to aneurysmal subarachnoid hemorrhage

作　　者：冯华[1] 唐卫华[1] 

机构地区：[1]第三军医大学西南医院神经外科全军神经系统疾病微创诊治专科中心全军神经创伤防治重点实验室,重庆400038

出　　处：《解放军医学杂志》2011年第12期1259-1262,共4页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金(30973101;30772224;30801186;30900466);重庆市国际合作重大项目(2011GZ0040)

摘　　要：颅内动脉瘤本身是一种良性疾病,但其伴发的动脉瘤性蛛网膜下腔出血(aSAH)却严重制约了临床疗效。前期的研究显示脑内大动脉痉挛是导致临床预后不良的关键因素,但近来内皮素A受体拮抗剂的临床实验结果却显示脑内大血管痉挛可能并非关键因素。aSAH的研究重点也因此转向了以微循环障碍、皮质播散性抑制、早期脑损害、血-脑脊液屏障损伤、炎症机制等为代表的新方向。在临床治疗上,有必要加强基层医院及相关科室对aSAH的认识及转诊意识,重视CT血管成像(CTA)的应用;根据病情选择夹闭及介入,尽早对动脉瘤进行确定性治疗,并积极防治脑血管痉挛。Intracranial aneurysm itself is a benign disease,but its associated aSAH restricted clinical outcomes seriously.Previous studies have shown that lager cerebral artery spasm is the key factor that leads to poor clinical prognosis.However,recent clinical trial of endothelin A receptor antagonist have shown a different result.Thus,aSAH research has shifted to some new focus,such as microcirculation dysfunction,cortical spreading depolarization,early brain injury,blood-cerebrospinal fluid barrier damage,and inflammation mechanism.In clinical treatment,strengthening the diagnosis and transfer treatment in primary hospital and related departments is necessary to emphasize the CTA applications.Early clipping and intervention should be done to make definite treatment according to the overall medical condition of the patient.In addition,active prevention of the cerebral vasospasm was conducted.

关 键 词：颅内动脉瘤 蛛网膜下腔出血 神经外科手术 

分 类 号：R651.122[医药卫生—外科学]