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动脉瘤性蛛网膜下腔出血后迟发性脑缺血管理策略

2019-07-21 王宁 中华医学信息导报

动脉瘤蛛网膜下腔出血脑缺血
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动脉瘤性蛛网膜下腔出血是严重损伤中枢神经系统并对全身多个器官产生病理影响的急性脑血管疾病。


王宁教授

动脉瘤性蛛网膜下腔出血是严重损伤中枢神经系统并对全身多个器官产生病理影响的急性脑血管疾病。脑血管痉挛（CVS）引起的迟发性脑缺血是影响预后的主要因素之一。重症动脉瘤性蛛网膜下腔出血患者均会发生不同程度的CVS改变。CVS后脑缺血和脑梗死的发生是多因素参与的。CVS的直接病理性影响包括导致其供血区域的脑血流量减少，造成迟发性脑缺血（DCI）。

DCI的诊断

（1）目前仍以数字减影血管造影为诊断CVS的金标准，但由于其有创性且难以重复和实时检查，限制了这一技术作为首选检查手段。（2）高质量的计算机断层成像血管造影可用于CVS的筛查。（3）经颅多普勒超声可以用于检测CVS的发生，不仅无创，而且可以反复、实时、连续检测，以大脑中动脉检测最为常用。

DCI的治疗

（1）改善血流动力学、增加脑灌注是DCI确诊后的初始治疗。（2）抗CVS药物治疗是重症动脉瘤性蛛网膜下腔出血后临床常规措施。（3）对表现为局灶性神经功能障碍，同时血管成像显示的病灶与症状相符者，若血流动力学疗法和药物治疗不能改善临床症状，可以进行血管内介入治疗，包括对狭窄血管进行球囊扩张成形术和对远端血管进行血管扩张药物的灌注。

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    2019-10-09 gous

    #管理策略#

    0

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    2019-08-11 aliceclz

    #蛛网膜#

    0

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    2020-06-09 经常头晕

    #迟发性#

    0

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    2019-07-26 小华子

    #迟发性脑缺血#

    0

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    2019-07-23 cqlidoudou

    #脑缺血#

    0

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    2019-07-23 紫砂壶

    #动脉瘤性蛛网膜下腔出血#

    0

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    2019-07-23 txqjm

    谢谢了，学习

    0

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