动脉瘤性蛛网膜下隙出血后脑血管痉挛的诊断和治疗进展

脑血管痉挛多见于动脉瘤性蛛网膜下隙出血（aneurysmal subarachnoid hemorrhage,aSAH）,常在出血后数天发现,1周后达高峰。其进展迅速,常引起局部脑缺血、脑梗死及神经功能障碍,是动脉瘤破裂后致死、致残的重要原因。脑血管造影是诊断脑血管痉挛的金标准,但近年来经颅多普勒超声、CT脑灌注成像、近红外线光谱等非侵袭性检查手段日趋流行,便于广泛开展。脑血管痉挛的治疗大体上分为血液动力学及药物治疗两类,早期清除血肿、舒张血管、增强脑灌注为主要研究方向,联合治疗是其今后的治疗趋势,本文就其诊断和治疗进展作一综述。

Advance in diagnosis and treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage

Cerebral vasospasm is common in aneurysmal subarachnoid hemorrhage (aSAH). It often occurs several days after aSAH, and then peaks at 1 week, causing local cerebral ischemia, cerebral infarction and neurological deficit dysfunction. Cerebral vasospasm is an important reason for death or disability after aneurysm rupture. Cerebral angiography is the gold standard for the diagnosis of cerebral vasospasm, but now transcranial Doppler ultrasound, CT cerebral perfusion imaging, near infrared spectroscopy and other non-invasive inspection methods are increasingly popular and easy to carry out extensively. Treatments of cerebral vasospasm include hemodynamics and drug therapy, with early removal of hematoma, diastolic blood vessels, and enhanced brain perfusion as the main research direction. Joint treatments are the future trends of cerebral vasospasm therapy. In this review, we summarized the diagnosis and treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage.