颅内动脉瘤夹闭术后脑血管痉挛的预见性护理

目的探讨如何加强围手术期护理,降低脑血管痉挛的发生,保证动脉瘤手术成功。方法对236例动脉瘤患者进行细致的围手术期护理,严密观察病情,及早发现并发症,及早正确处理。结果236例患者出现症状性脑血管痉挛57例,其中好转53例,放弃治疗3例,死亡1例。结论做好围手术期护理,利用护理手段干预可控因素,保证脑的有效灌注压,可预防脑血管痉挛的发生。     

超选择动脉内灌注及血管成形术治疗脑血管痉挛

目的探讨早期超选择动脉内灌注及血管成形术 (PTA)治疗脑血管痉挛 (CVS)的效果。方法对 6例动脉近端狭窄段进行球囊扩张 ,对 3 8例大脑中动脉M2 段、大脑前动脉A1和A2 段痉挛者 ,灌注 0 .3 %罂粟碱 3 0 0～ 40 0ml,观察全脑血管造影和评价神经功能状态。结果复查全脑血管造影见痉挛血管全部有改善 ,术后 48小时临床状态和神经功能状态均得到改善 ,无死亡。术后 3月随访 ,恢复良好 2 7例 ,中度致残、生活能自理 11例。结论对于近端、局限性CVS宜采用PTA ,而对于远端、弥漫性CVS需采用超选择脑动脉内灌注罂栗碱治疗     

超选择性动脉内灌注尼莫地平治疗蛛网膜下腔出血后脑血管痉挛

目的　探讨超选择性动脉灌注尼莫地平治疗蛛网膜下腔出血 (SAH )后脑血管痉挛 (CVS)的可行性 ,以降低SAH病人的复发率及病死率。方法　 3 8例病人随机分为两组 ,治疗组 18例采用Seldinger技术经右侧股动脉穿刺 ,明确血管痉挛狭窄部位后 ,缓慢灌注尼莫地平针剂 0 .3～ 0 .5mg ;对照组 2 0例给予尼莫地平口服 ,40mg/d。 结果　两组病人在缓解剧烈头痛 ,降低再发率、病死率、并发症等方面具有十分显著的差异 ,应用动脉灌注尼莫地平治疗者明显优于不使用该方法者。结论　动脉内尼莫地平的灌注 ,对治疗严重的血管痉挛是有效的 ,使用超选择性灌注技术具有更大的优越性。     

血管内栓塞治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛病人的护理

[目的]探讨血管内栓塞治疗动脉瘤性蛛网膜下腔出血(aSAH)后并发脑血管痉挛(CVS)病人的护理方法。[方法]对在神经内科住院行血管内栓塞治疗术后并发CVS的 aSAH 24例病人实施全面的护理,包括监测 CVS前驱症状及体征、保持等容和正常循环血量、正确使用尼莫地平、做好腰椎穿刺放脑脊液的护理及心理护理。[结果]23例治愈出院,1例发生迟发性缺血性神经功能障碍,遗留右侧肢体轻瘫出院。[结论]对血管内栓塞治疗aSAH 后CVS的病人实施全面的护理,可及早发现病人的病情变化,遏制CVS的发展。     

蛛网膜下腔出血后脑血管痉挛的治疗进展

脑血管痉挛 (ＣＶＳ)是蛛网膜下腔出血 (ＳＡＨ)早期最严重的并发症 ,发生率高达 16 %～ 6 6 % [1] ,是ＳＡＨ患者病残和致死的主要原因。ＳＡＨ后ＣＶＳ的发病机制至今尚未完全明确 ,但随着医学科学的发展对ＳＡＨ后ＣＶＳ有了新的认识 ,并在治疗上提出了一些新的治疗方法 ,现综述如下。1　药物治疗1.1　钙通道阻滞剂的应用　ＳＡＨ后血管内皮细胞和平滑肌细胞Ｃａ2 + 大量内流 ,激活一系列生物反应 ,引起平滑肌兴奋收缩是ＳＡＨ后ＣＶＳ的主要理论之一[2 ] 。钙通道阻滞剂正是通过抑制这一过程达到解除血管痉挛的目的。目前公认治疗效果较…     

蛛网膜下腔出血后脑血管痉挛治疗新进展

蛛网膜下腔出血后脑血管痉挛是一种常见并发症 ,常引起严重的局部脑组织缺血或迟发性缺血性脑损害。目前 ,伴发血管痉挛的病理发生和基因表达了解甚少。有关其治疗方法很多 ,但均不大理想 ,现就其治疗进展作一综述     

蛛网膜下腔出血后脑血管痉挛研究进展

蛛网膜下腔出血是神经外科常见急症,致死率较高,幸存者多伴有神经及认知功能障碍。脑血管痉挛是蛛网膜下腔出血的常见并发症和致残、致死的重要原因,对其病理生理学机制的研究将促进治疗方案的改进,有助于改善患者的预后。     

尼莫地平治疗蛛网膜下腔出血后脑血管痉挛研究进展

脑血管痉挛一直被认为是蛛网膜下腔出血后严重的并发症,鉴于钙离子超载在脑血管痉挛的发生机制中的重要地位,许多学者致力于钙离子阻滞剂预防和治疗脑血管痉挛研究。其中,尼莫地平的疗效确切,被作为临床预防和治疗脑血管痉挛的推荐药物。现就尼莫地平治疗脑血管痉挛的研究进展作一综述。     

动脉瘤性蛛网膜下腔出血后脑血管痉挛的治疗进展

动脉瘤性蛛网膜下腔出血后脑血管痉挛是患者致死或致残的主要原因，近年来随着对蛛网膜下腔出血后脑血管痉挛的发病机制研究的不断深入。其治疗的种类和方法均有了新的进展。     

尼莫通治疗蛛网膜下腔出血后脑血管痉挛40例

作者于2001年1月~2004年12月对40例确诊蛛网膜下腔出血(SAH)的患者使用尼莫通防治SAH后的脑血管痉挛(CVS)的疗效进行了临床观察。1临床资料蛛网膜下腔出血患者共60例,随机分为2组。治疗组40例,男26例,女14例,年龄27~74岁,平均48.5岁;对照组20例,男12例,女8例,年龄30~67岁,平均4     

高血糖对动脉瘤出血后症状性脑血管痉挛的影响

目的探讨动脉瘤性蛛网膜下腔出血后血糖水平与症状性脑血管痉挛的发生及预后的关系。方法回顾性分析175例动脉瘤性蛛网膜下腔出血患者的临床特征和血糖水平。用Cox回归来分析入院时血糖的平均值、住院期间血糖的平均值、胰岛素用量、糖尿病病史、Hunt-Hess分级、Fisher分级。结果在175例患者中,53例(30.4%)发生症状性血管痉挛。入院时血糖为(9.7±2.2)mmol/L和住院期间血糖值(9.2±1.4)mmol/L相比,显著升高。多因素分析显示,住院期间血糖值[RR=1.02,95%可信区间(CI)1.02~1.04],Hunt-Hess≥3级[RR=2.22,95%可信区间(CI)1.20~3.98],FisherⅢ级[RR=1.26,95%可信区间(CI)1.14~3.0]是影响症状性血管痉挛发生的危险因素。结论高血糖是症状性脑血管痉挛发生的相关因素,控制高血糖可减少症状性脑血管痉挛的发生,改善临床预后。     

硫酸镁逆转SAH后脑血管痉挛的实验研究

目的:探讨硫酸镁对蛛网膜下腔出血(SAH)后脑血管痉挛的防治作用。方法:采用“枕大池一次注血法”复制兔SAH模型,治疗组予硫酸镁静脉输入,单纯注血组则予等量生理盐水。术前和术后全程观察实验动物的饮食及神经功能变化情况,利用HE染色及透射电镜分别观察各组处理后第5天兔基底动脉血管形态学及超微结构改变。结果:(1)单纯注血组兔摄食量逐渐下降、神经功能障碍逐渐加重;治疗组摄食量稍有下降,神经功能障碍较轻,且逐渐好转。(2)单纯注血组兔基底动脉血管管径显著小于正常组(P<0.01),而经硫酸镁处理后,治疗组血管管径明显大于单纯注血组(P<0.05),与正常组差异无显著性(P>0.05),部分管径甚至大于正常组。(3)单纯注血组血管壁增厚、结构紊乱,内皮细胞紧密连接消失,内弹力膜皱折、虫蚀样改变,平滑肌细胞变性、核扭曲等。治疗组上述结构改变较轻。结论:硫酸镁能明显逆转SAH后的脑血管痉挛,且有良好的神经保护作用。     

Possible overlap between reversible cerebral vasoconstriction syndrome and symptomatic vasospasm after aneurysmal subarachnoid hemorrhage

A 34-year-old woman with a previous history of severe headache (“thunderclap”) was admitted with a diagnosis of aneurysmal subarachnoid hemorrhage (SAH). The patient developed symptomatic vasospasm on day 5 that resolved rapidly after having increased arterial blood pressure. She experienced also short-lasting excruciating headache. On day 12, while velocities had normalised, as revealed by transcranial Doppler (TCD), for more than 48 h, she developed aphasia and right hemiplegia associated with diffuse segmental vasospasm on the left middle cerebral artery. Intra-arterial infusion of vasodilatory agents was required. Recurrence of symptomatic vasospasm was noted on day 25, with a great number of territories involved as shown in the cerebral angiogram. A second intra-arterial treatment was needed. The patient complained of multiple episodes of extremely severe headache (“thunderclap”), with also transient dysarthria and hemiparesia on day 30. She was discharged on day 38 after full recovery. The clinical and TCD/radiological findings were consistent with a reversible cerebral vasoconstriction syndrome overlapping SAH related symptomatic vasospasm.     

氧化苦参碱对蛛网膜下腔出血大鼠脑血管痉挛的作用及机制研究

目的探讨氧化苦参碱（OMT）对蛛网膜下腔出血（SAH）大鼠脑血管痉挛的作用及机制的研究。 方法将200只雄性大鼠分成假手术组、SAH组、小剂量组和大剂量组,每组50只。采用枕大池二次注血法制作SAH大鼠模型,假手术组大鼠两次均注入等量生理盐水,其余三组在模型建立后分别给予1 ml的0.9%氯化钠注射液,60和120 mg/kg的OMT腹腔注射。在术后1、3、5、7和10 d每组分别处死10只大鼠,测量四组大鼠基底动脉血管直径,检测基底动脉内皮细胞核因子κB（NF-κB）、胞外信号调节激酶（ERK）1/2、p38丝裂原活化蛋白激酶（MAPK）、c-Jun氨基末端激酶（JNK）的蛋白相对表达量,以及基底动脉内皮细胞白细胞介素1β（IL-1β）、IL-6和肿瘤坏死因子α（TNF-α）的mRNA相对表达水平。 结果术后3、5、7和10 d,四组大鼠基底动脉血管直径（F = 11.897、28.957、14.785、8.381,P均< 0.05）,基底动脉内皮细胞NF-κB（F = 17.289、65.602、43.881、26.998,P均< 0.05）、ERK1/2（F = 204.331、145.948、107.442、30.332,P均< 0.05）、p38MAPK（F = 84.908、116.677、83.735、28.338,P均< 0.05）和JNK（F = 26.809、83.419、56.465、27.756,P均< 0.05）蛋白表达,以及基底动脉内皮细胞IL-1β（F = 66.625、262.620、283.499、218.081,P均< 0.05）、IL-6（F = 38.580、170.657、136.253、58.068,P均< 0.05）和TNF-α（F = 31.290、361.661、101.109、23.940,P均< 0.05）mRNA水平的比较,差异均有统计学意义（P均< 0.05）。其中术后3、5、7和10 d时间点上,假手术组和大剂量组大鼠基底动脉血管直径均较SAH组显著增大（P均< 0.05）,而这两组的基底动脉内皮细胞NF-κB、ERK1/2、p38MAPK和JNK的蛋白表达,以及IL-1β、IL-6和TNF-α的mRNA表达均显著少于SAH组（P均< 0.05）。但小剂量组的以上指标和SAH组比较差异均无统计学意义（P均> 0.05）。 结论OMT可改善SAH大鼠脑血管痉挛,其机制可能与OMT抑制脑血管内皮细胞NF-κB、ERK1/2、p38MAPK和JNK等信号通路,降低大鼠基底动脉血管炎症反应有关。     

Prevention of delayed cerebral vasospasm by continuous intrathecal infusion of glyceroltrinitrate and nimodipine in the rabbit model in vivo

Objective Intrathecal bolus administration of nitric oxide donors and calcium channel antagonists has been proposed to reduce cerebral vasospasm (CVS) in animal subarachnoid hemorrhage (SAH) models. Intrathecal continuous administration of these substances for CVS prevention has not been extensively evaluated. This study compared the efficacy of continuous intrathecal infusions of the NO donor glyceroltrinitrate and nimodipine in preventing delayed CVS associated with SAH in an animal model in vivo. Methods New Zealand White rabbits were randomly assigned to six groups: no SAH/NaCl, no SAH/NO, no SAH/nimodipine, SAH/NaCl, SAH/NO, or SAH/nimodipine. Glyceroltrinitrate (GTN) at 0.5 μg/μl (0.5 μl/h) or nimodipine at 0.2 μg/μl (10 μl/h) or NaCl was continuously infused into the cisterna magna via an Alzet osmotic pump from day 0 to day 5 after injection of 1.0 ml autologous blood. The magnitude of spasm in the basilar artery was determined by comparison of pre- and posttreatment angiography and was calculated as proportional change in intraluminal diameter based on automatic measurements. Results A total of 55 experiments and 110 angiograms were performed. SAH was associated with vasoconstriction of the basilar artery (SAH/NaCl group 19.85 ± 2.94%). Continuous intrathecal injection of GTN and nimodipine prevented SAH-induced CVS. There was significant prevention of CVS in animals treated with GTN (SAH/NO group 5.93 ± 5.2%, n = 11) and nimodipine (SAH/nimodipine group: 0.55 ± 2.66%, n = 9). There was no significant difference between the treatment groups and controls in prevention of CVS. Conclusions This study demonstrates that prophylactic continuous intrathecal administration of either GTN or nimodipine equally prevents SAH-associated CVS in an animal model. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. This study was supported by the Cerebrovascular Research Fund from the Departments of Neurosurgery and Intensive Care Medicine (account no. 34-160), University of Berne, Switzerland.     

蛛网膜下腔出血的CT灌注成像研究

目的：探讨CT灌注成像评估蛛网膜下腔出血后脑血流动力学变化的价值。方法：实验组21例蛛网膜下腔出血（包括延迟发生脑梗死3例）和7例对照组病人进行CT灌注成像,比较各脑叶CT灌注参数值的差异。结果：实验组中有10例病人在灌注图上发现肉眼可见的低灌注区,CT平扫未见低密度改变。CBF值在实验组中发生延迟脑梗塞组为21.35±3.42,不发生组为23.37±2.29,对照组为26.59±2.47,实验组与对照组之间有显著性差异;TTS值延迟脑梗塞组为32.26±12.08,无延迟脑梗塞组为19.14±4.88,两者之间具有显著性差异,其余灌注参数在各组之间未见显著性差异。结论：CT灌注成像能够反映蛛网膜下腔出血后的脑血流动力学变化。     

脑底池连续泵输注罂粟碱防治动脉瘤术后血管痉挛

目的探索脑底池连续泵输注罂粟碱对腑动脉瘤破裂早期手术后的血管痉挛的防治作用,以提高手术治疗效果及患者生存质量。方法对13例经头颅CT三维血管成像和全脑血管造影检查诊断为脑动脉瘤破裂伴SAH患者,行早期急诊手术开颅脑动脉瘤颈夹闭,用PCA泵脑底池连续输注罂粟碱,经腰大池引流脑脊液,直至罂粟碱输注治疗结束同时观察脑血管痉挛临床五项指征。结果13例患者输注罂粟碱8d的11例,10d的2例。患者全部存活,术后无脑血管痉挛和不良反应。结论脑底池连续输注罂粟碱防治脑动脉瘤破裂、蛛网膜下腔出血术后血管痉挛,效果确切,安全可行。     

The effect of vasospasm on cerebral perfusion: a colour duplex study of the extra- and intracranial cerebral arteries

To assess whether middle cerebral artery (MCA) vasospasm reduces the flow volume in the corresponding extracranial internal carotid artery (ICA) or global cerebral blood flow volume (CBFV) in subarachnoid haemorrhage (SAH) patients, a colour duplex ultrasound study of the intra- and extracranial cerebral arteries was performed. MCA vasospasm was defined as a time-averaged maximum flow velocity (TAMX) exceeding 120 cm/s. ICA flow volumes and CBFV, were compared in each patient at maximum TAMX recorded in one MCA ("maximum-vasospasm") and when TAMX in the same vessel was closest to mean reference values ("no-vasospasm"). Additionally, the CBFV course during the first 3 weeks after SAH was evaluated longitudinally. Data from age- and gender-matched healthy test persons served as control. In 28 patients with MCA vasospasm, 337 measurements were completed. Global CBFV was significantly reduced starting from day 3 after SAH. ICA flow volumes and CBFV were not different when comparing at "maximum-vasospasm" and "no-vasospasm". Compared with the control group, both were lower at either condition. Thus, in SAH patients, vasospasm even severe, in general does not further diminish ICA flow volumes and global CBFV, which are reduced already before the onset of vasospasm.