尼莫地平对兔蛛网膜下腔出血后症状性脑血管痉挛的影响

目的探讨尼莫地平对兔蛛网膜下腔出血（SAH）后症状性脑血管痉挛的影响。方法建立症状性脑血管痉挛动物模型，SAH＋尼莫地平组静脉内应用尼莫地平。观察对比神经功能缺损症状改善、血液流变学及电镜结果。结果SAH＋尼莫地平组随着尼莫地平的应用,神经功能缺损症状逐渐好转、血液流变学得到改善、透射电镜见基底动脉病理改变较SAH组减轻。结论SAH后早期应用尼莫地平对症状性脑血管痉挛具有明显的改善作用。     

老年蛛网膜下腔出血患者脑脊液中溶血磷脂酸含量的动态变化

目的观察老年蛛网膜下腔出血(SAH)患者脑脊液中溶血磷脂酸(LPA)含量动态变化的特点与脑血管痉挛(CVS)的关系。方法选择经临床和辅助检查确诊的SAH患者67例为SAH组,另选同期住院的非SAH患者55例为对照组,分别于发病后1、7、14及28天测定脑脊液中LPA的含量,又将SAH组患者经脑血管造影和经颅多普勒超声确诊后分为CVS组(21例)和无CVS组(46例)。结果SAH组患者发病1天时脑脊液中LPA含量与对照组比较差异无显著性意义;SAH组患者发病7天时明显升高(P<0.01);14天时仍高(P<0.01),28天降至基线水平。CVS组患者发病1天时脑脊液中LPA含量与无CVS组比较差异无显著性意义;CVS组患者发病7天时明显升高(P<0.01);14天时仍高(P<0.01),28天降至基线水平。结论SAH后7和14天脑脊液中LPA含量与CVS的发生明显关联。检测脑脊液中LPA含量对预测CVS的发生可能具有重要意义。     

Angiographically documented cerebral vasospasm following transsphenoidal surgery for pituitary tumors

Symptomatic cerebral vasospasm (CVS) after transsphenoidal surgery (TSS) is very rare compared with vasospasm resulting from aneurysmal subarachnoid hemorrhage (SAH). Fewer than six cases documented by cerebral angiography have been reported. We evaluated the records of 15 patients in whom SAH developed after TSS. Their clinical symptoms, radiological and laboratory findings were analyzed. Among 15 patients with postoperative SAH, 11 did not show CVS during their postoperative course. However, four patients presented with various clinical symptoms suggestive of CVS on postoperative days 7–9. They showed an abrupt drop of serum sodium level 1 or 2 days before the onset of CVS symptoms. Patients with TSS-related SAH should be managed with proactive and aggressive treatment. Hyponatremia, which usually occurs around the first week after TSS, should not be ignored as a matter of metabolic or hormonal disequilibrium commonly encountered after pituitary surgery.     

硫酸镁防治蛛网膜下腔出血后脑血管痉挛、迟发性脑缺血和再出血

目的:观察硫酸镁静滴防治蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)、迟发性脑缺血(DCI)和再出血的疗效。方法:106例SAH患者,随机分为硫酸镁治疗组和尼莫地平治疗组,每组53例。两组均采用相同的基础治疗和对症处理。硫酸镁治疗组加用生理盐水500mL+25%硫酸镁15mL,维持静滴,2次/d;14d后改为1次/d,7d后停用。尼莫地平治疗组加用生盐水500mL+尼莫地平10mg维持静滴,2次/d,14d后改为1次/d,7d后停用。床旁TCD监测了解CVS程度和DCI情况。定期复查头部CT了解颅内出血和缺血情况及其程度。结果:第31天时硫酸镁治疗组和尼莫地平治疗组发生CVS、DCI或再出血者分别为15例和26例(P<0.05),其中CVS分别为6例和8例(P>0.05),DCI分别为3例和11例(P<0.05),再出血分别为6例和7例(P>0.05)。仍有神经功能缺损分别为5例和12例(P<0.01),死亡分别为5例和11例(P<0.01)。结论:硫酸镁在防治SAH后CVS和再出血的疗效与尼莫地平相近,但在防治DCI和降低神经功能缺损和病死率方面优于尼莫地平。     

蛛网膜下腔出血后铁代谢机制的研究进展

脑血管痉挛(CVS)是蛛网膜下腔出血(SAH)的常见并发症,是SAH患者致死、致残的主要原因之一.近年来对其发病机制及治疗方法进行了深入的研究,发现铁代谢在SAH后脑血管痉挛中有着重要作用.本文就近年来国内外学者在SAH后铁代谢病理生理机制的研究进展作一综述.     

CT血管造影评价兔基底动脉痉挛模型

目的探讨采用多层螺旋CT血管造影（multi-slices CT angiography，MSCTA）技术显示兔基底动脉，为兔脑血管痉挛（cerebralvasospasm，CVS）动物模型建立新的评价方法。方法取日本大耳白兔25只，分为对照组（5只）和蛛网膜下腔出血（subarachnoid hemorrhage，SAH）组（20只）。SAH组采用枕大池二次注血法制作兔脑基底动脉CVS模型，均经兔耳后中央静脉穿刺注射非离子型对比剂（碘海醇，含碘量300mg／m1），剂量按2．6ml／kg（体重）。采用高压注射器给药，注射速度0．4ml／s，延时15S开始扫描。SAH组于注血后1、4、7、11d，行2～5次基底动脉MSCTA。原始图像三维后处理技术采用容积重建（volume rendering，VR）。结果SAH组注血后1、4、7、11d基底动脉直径分别为（1．28±0．36）、（0．82±0．24）、（0．83±0．20）及（0．95±0．28）mm。VR法测得实验兔注血前基底动脉横径平均为（1．30±0．40）mm。CVS在注血后第1天出现，第4天达到高峰，第11天可见基底动脉痉挛有一定程度的缓解。结论MSCTA技术能够较理想地显示兔基底动脉，是评价活体动物CVS模型的可靠方法。     

脑脊液溶血磷脂酸含量与蛛网膜下腔出血后脑血管痉挛的关系

目的:观察蛛网膜下腔出血(SAH)患者脑脊液溶血磷脂酸(LPA)含量动态变化的特点及其与脑血管痉挛(CVS)的关系,探索CVS的发病机制.方法:选取经临床和辅助检查确诊的SAH患者67例,分别于发病后24 h、7 d、14 d和28 d测定脑脊液LPA含量,并与对照组进行比较,同时观察LPA含量与CVS在时程上的相关性.结果:67例SAH患者中共有29例(43.3%)发生CVS,平均发生时间为6.6 d.发病24 h时,SAH患者脑脊液LPA含量与对照组无显著差异;发病7 d时显著高于对照组(P＜0.001);发病14 d时显著高于对照组(P＜0.01),但显著低于发病7 d时(P＜0.01);发病28 d时降至基线水平,与对照组无显著差异.发病24 h时,CVS组脑脊液LPA含量与无CVS组无显著差异,发病7 d时显著高于无CVs组(P＜0.001),发病14 d时仍显著高于无CVS组(P＜0.01);发病28 d时两组之间无显著差异.结论:SAH患者脑脊液LPA水平在发病后7～14 d显著升高,并且在时程上与CVS发生显著关联.检测脑脊液12A含量对预测CVS的发生可能具有重要意义.     

蛛网膜下腔出血后脑血管痉挛患者血清C反应蛋白的变化及临床意义

目的观察蛛网膜下腔出血(SAH)患者的C反应蛋白(CRP)的变化,探讨C反应蛋白在SAH及并发脑血管痉挛(CVS)中的临床意义。方法将19例急性SAH患者分为CVS组(9例)和非CVS(10)组,测量两组患者第3、7、14天的CRP。结果CVS组和非CVS组在发病后第3、7和14天的CRP水平明显升高(P<0.01);CVS组在第7天的CRP水平明显高于第3天,而非CVS组中CRP水平在第7天和第14天明显低于第3天(P<0.01);CVS组在第3天、第7天和第14天的CRP水平也明显高于非CVS组同期水平(分别为P<0.05、P<0.01、P<0.01)。结论CRP对于病情的监测和预后具有重要作用。     

阿托伐他汀对蛛网膜下腔出血后脑血管痉挛的干预作用

目的 探讨应用阿托伐他汀对蛛网膜下腔出血(SAA)后脑血管痉挛(CVS)的干预作用.方法 取健康SD雄性大鼠30只,随机将大鼠分为假手术组、SAH组、阿托伐他汀组,每组10只大鼠.以上各组分别于第1次手术后7 d灌注处死,取基底动脉行HE染色,测量其内径周长和管壁厚度;TUNEL法检测BA平滑肌细胞的凋亡率.结果假手术组、SAH组和阿托伐他汀组基底动脉的内径周长和管壁厚比较,三组之间两两比较均有统计学意义(P<0.05或P<0.01).各组基底动脉平滑肌细胞的凋亡率比较,三组之间两两比较均有统计学意义(P<0.05).结论 阿托伐他汀可以诱导基底动脉平滑肌细胞的凋亡,早期应用对SAH后引发的CVS有一定的缓解作用.     

Herbal medicines for the prevention and treatment of cerebral vasospasm after subarachnoid hemorrhage: A protocol for systematic review and meta-analysis

Background:Despite the rapid advances in medical technology, including endovascular interventions and medications, cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) is still one of the major threats to the lives of patients with SAH. In East Asian countries, various types of herbal medicines have been used to treat cerebrovascular diseases, including SAH. In this review, we aim to evaluate the efficacy and safety of herbal medicines for the prevention and treatment of CVS after SAH.Methods and analysis:Seven databases will be searched for relevant studies from inception to the present date “June 2020”. Only randomized controlled trials (RCTs) that assess the effect and safety of herbal medicines for the prevention and treatment of CVS after SAH will be included. The methodological quality will be evaluated using the Cochrane risk of bias assessment tool. After selecting the appropriate studies, a meta-analysis of the RCTs will be performed.Results:This study will provide a high-quality synthesis of current evidence of herbal medicines for CVS after SAH.Conclusion:Our systematic review will provide evidence to judge whether herbal medicines are effective interventions for patients with CVS after SAH.Ethics and dissemination:Ethical approval is not required, as this study is based on a review of published research. This review will be published in a peer-reviewed journal and disseminated electronically and in print.Trial registration number:Research registry reviewregistry923.     

超选择性动脉内灌注维拉帕米治疗蛛网膜下腔出血后脑血管痉挛的疗效分析

目的探讨超选择性动脉内灌注维拉帕米治疗动脉瘤性蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)的疗效。方法回顾性分析2013年1月至2016年2月对颅内动脉瘤开颅夹闭(8例)或血管内治疗(7例)后出现CVS 15例SAH患者的临床资料,对15例患者均进行全脑DSA,使用微导管超选择至痉挛的动脉并灌注维拉帕米(11.1±3.4)mg,对照治疗前后全脑DSA表现,搜集治疗过程中血压、心率,记录灌注前后经颅多普勒超声结果,随访6个月并进行格拉斯哥预后评分(GOS)。结果 (1)对15例患者共实施了20支动脉内的灌注治疗,灌注前后比较,DSA上CVS改善14例,无明显变化1例。(2)经颅多普勒超声检查大脑中动脉的平均脑血流速度(mBFV),由超选择灌注术治疗前的(181±4)cm/s降至治疗后1 h内的(126±4)cm/s,差异有统计学意义(t=42.46,P0.01),无一例发生使用微导管所导致的并发症。(3)灌注过程中监测患者右上臂血压,灌注开始时收缩压为(138±8)mmHg,灌注结束时为(135±10)mmHg,术后1 h为(137±7)mmHg;手术开始时心率为(83±6)次/min,手术结束时为(79±8)次/min,至术后1 h为(80±5)次/min,差异均无统计学意义(P0.05)。(4)对所有患者随访6个月,6个月时的GOS评分:恢复良好9例,中度病残但能生活自理3例,重度病残生活不能自理3例。无一例植物生存或死亡。结论超选择性动脉内灌注维拉帕米,能有效改善动脉瘤性SAH造成的CVS,同时对心率及血压无明显影响。     

老年蛛网膜下腔出血患者脑血管痉挛的相关危险因素回顾性分析

目的探讨老年蛛网膜下腔出血(SAH)患者发生脑血管痉挛(CVS)的相关危险因素。方法选择SAH患者62例,以是否发生CVS,将患者分为CVS组(27例)和非CVS组(35例),比较2组基线资料,并对住院前和住院期间发生CVS的相关因素进行logistic分析和COX分析。结果与非CVS组比较,CVS组患者吸烟、糖尿病、高血压年限及发热时间更长(P0.05,P0.01)。WBC计数明显增高(OR=1.515,95% CI:1.045～1.247,P=0.028)是CVS预测因素;吸烟(RR=1.044,95% CI:1.010～1.078,P=0.010)和高血压(RR=1.092,95% CI:1.025～1.163,P=0.006)是住院期间CVS独立危险因素;适当延长住院时间可以降低CVS的发生(RR=0.931,95% CI:0.878～0.987,P=0.016)。由于样本量小,糖尿病是住院前和住院期间发生CVS的低概率危险因素。结论吸烟、高血压、入院时WBC计数增高的老年SAH患者CVS发生风险显著增加;适当延长住院时间,可以降低CVS风险。     

Pharos neurovascular intracranial stent: Elective use for a symptomatic stenosis refractory to medical therapy

The Warfarin‐Aspirin Symptomatic Intracranial Disease study investigators demonstrated that medically managed patients with symptomatic intracranial stenosis experience a 7–11% annual stroke risk. Early treatment efforts utilized balloon‐mounted coronary stents, which provided excellent angiographic results (postprocedure stenoses <10%), versus percutaneous transluminal angioplasty (PTA) alone (40%). However, the rigidity of balloon‐mounted coronary stents provided limited access to the tortuous cerebrovasculature. Self‐expanding stents became available for intracranial stenosis treatment in 2002. With increased flexibility, immediate results were encouraging (approximately 30% residual stenosis). However, midterm results have demonstrated disappointingly high rates of restenosis. To address these issues, the Pharos Neurovascular Stent System (Pharos, Micrus Endovascular, San Jose, CA) was developed. The Pharos is a balloon‐expandable stent mounted on a rapid‐exchange PTA catheter especially designed for intracranial endovascular applications. Utilizing the Pharos, we obtained an outstanding angiographic result (0% residual stenosis), with no associated morbidity. The patient was discharged home on postprocedure day 1 and remained symptom‐free, with no in‐stent stenosis, 3 months later. Our experience with the Pharos supports early literature suggesting that this stent may be a valuable treatment option for patients with medically refractory intracranial stenosis. © 2009 Wiley‐Liss, Inc.     

动脉瘤性蛛网膜下腔出血后脑血管痉挛的种族差异的系统评价：中国患者与欧洲患者的比较

目的分析和比较中国与欧洲地区动脉瘤性蛛网膜下腔出血（aneury smal subarachnoid hemorrhage，aSAH）患者脑血管痉挛(cerebral vasospasm,CVS)发生率。方法利用MEDLINE和CNKI数据库对所有探讨aSAH后CVS发生率、诊断、治疗或预后的临床研究进行检索（检索时间...     

蛛网膜下腔出血后脑血管痉挛的危险因素

脑血管痉挛(CVS)是蛛网膜下腔出血(SAH)患者死亡和残疾的主要原因。CVS的发生率约为30%-60%,一般于SAH后3-4d开始出现症状,第2周达高峰,需3周左右恢复。早期评价病情和预测CVS的发生,有利于预防和恰当的治疗,降低病死率和致残率。文章对SAH后CVS的危险因素做了综述。     

犬脑血管痉挛经皮腔内血管成形术治疗

目的　探讨经皮腔内血管成形术 (PTA)治疗顽固性脑血管痉挛的可行性和效果。方法　成年杂种犬 2 0只 ,采用枕大池两次注血模型。应用扩张后直径为 1.5mm的硅胶球囊 ,扩张压力为 2个大气压、持续时间 10s,在痉挛的基底动脉近、远端分别扩张 1次。结果　 2 0只犬的基底动脉均发生痉挛 ,为其中的 14只进行了PTA治疗 ,成功13只、死亡 1只 ;另外的 6只犬 ,由于血管解剖原因 ,无法进行PTA操作。PTA治疗后 ,痉挛的基底动脉明显扩张 ,犬神经功能恢复明显加快。 2 0d后复查脑血管造影 ,接受PTA治疗犬的基底动脉显影基本正常 ,而未进行PTA治疗犬的基底动脉仍有明显的痉挛。结论　PTA是治疗顽固性脑血管痉挛的一种有效方法     

经皮血管成形术治疗肾动脉纤维肌性发育不良的临床疗效

目的评价经皮血管成形术（PTA）治疗肾动脉纤维肌性发育不良（FMD）的疗效及安全性。方法连续入选我院近6年来因严重高血压入院,经肾动脉造影确诊为肾动脉FMD并行PTA的患者。回顾性分析其临床特点,并随访血压、降压药使用情况和PTA治疗效果。结果共入选20例患者,年龄13～47岁（平均24.5±7.8岁）,其中女性12例（60.0%）。肾动脉造影显示共23条肾动脉受累,其中21条肾动脉直径狭窄〉60%的患者行肾动脉成形术,包括单纯球囊扩张17例（80.9%）,球囊扩张加支架置入4例（19.1%）,技术成功率为95.2%（20/21）。经过1～6年随访,改为肾动脉逐年累积再狭窄发生率为15.0%,20.7%,26.3%,33.7%,33.7%,33.7%。结论 PTA治疗肾动脉FMD安全有效。     

脑血管痉挛的机制和防治

脑血管痉挛(CVS)是导致动脉瘤性蛛网膜下腔出血(SAH)患者死亡和残疾的主要原因之一。尽管对SAH后CVS进行了广泛的研究,但其发病机制仍未完全阐明,红细胞分解产物、血管内皮功能障碍以及炎症反应在其中起关键作用。脑血管造影仍然是诊断CVS的金标准,但随着检测技术的发展,经颅多普勒、MRI和CT等无创性手段在SAH和CVS诊断中的地位越来越重要。对CVS的处理包括5个层面(1)在SAH后尽早预防CVS;(2)在发生CVS后纠正动脉狭窄;(3)预防动脉狭窄引起的脑缺血;(4)治疗动脉狭窄引起的脑缺血;(5)保护脑组织免受缺血损伤。     

Effects of extract of Ginkgo biloba on spasms of the basilar artery and cerebral microcirculatory perfusion in rats with subarachnoid hemorrhage

This study was aimed at investigating the effects of extract of Ginkgo biloba (EGb) on cerebral vasospasm and microcirculatory perfusion after subarachnoid hemorrhage (SAH). An endovascular piercing method was used to induce Wistar rat SAH models, and animals were divided into sham-operated, vehicle controls, and EGb-treated groups. EGb was injected intraperitoneally 30 minutes before operation and was repeated every 6 hours, with a single dose of 15 mg/kg bw. Diameters of basilar arteries before and after operation were measured. Microcirculatory blood perfusion of parietal lobe cortex was detected using a laser Doppler flow-meter probe within 24 hours. Endothelin-1 levels in both plasma and brain tissue were detected at different time points. The results showed that SAH caused an immediate drop in microcirculatory blood flow in vehicle controls, which persisted for 24 hours. Endothelin-1 levels in both plasma and brain tissue increased after SAH. EGb partly reversed spasms of the basilar artery and antagonized a drop in microcirculatory blood flow. EGb also prevented an increase in endothelin-1 both in plasma and in brain tissue. In conclusion, EGb, by antagonizing the overproduction of endo- thelin-1, partly reverses cerebral vasospasm and improves microcirculation, and thus relieves secondary ischemic brain injury after experimental SAH.     

辛伐他汀对兔脑血管痉挛中炎性反应的影响

目的探讨辛伐他汀对兔蛛网膜下腔出血（SAH）后脑血管痉挛（CVS）中炎性反应的影响。方法36只新西兰大白兔随机分为3组,每组12只。①对照组：给予常规饲养并枕大池二次注入等渗盐水;②sAH组：通过枕大池二次注血法建立SAH模型;③SAH＋辛伐他汀组：对SAH兔经胃灌注辛伐他汀5mg·kg^-1·d^-1,连续7d。在各组兔造模前后,行两次脑血管造影。第2次脑血管造影后1d,取基底动脉组织制作病理切片,分别于光镜和透射电镜下观察其显微及超微结构。行免疫荧光染色后,采用共聚焦显微镜观察基底动脉内皮细胞核转录因子-κB（NF—kB）表达量的变化,同时采用实时荧光定量PCR技术检测其细胞间黏附分子1（ICAM-1）mRNA的表达。结果①脑血管造影显示二次注血后,SAH组兔基底动脉出现明显的痉挛,管径变细,SAH组的管径为（0．68±0．09）mm,对照组为（0．87±0．06）mm,P〈0．05;而给予辛伐他汀后,痉挛减轻,SAH＋辛伐他汀组的管径为（0．77±0．08）mm,与SAH组管径比较,P〈0．05。SAH组兔基底动脉壁略有增厚,电镜显示平滑肌细胞内合成旺盛;而给予辛伐他汀预处理后,这些变化明显减轻。@SAH组兔基底动脉管壁内皮细胞内NF—κB表达高于对照组（156±9和84±8,P〈0．05）,而给予辛伐他汀后,NF—κB表达量降低（118±9）,与SAH组比较,P〈0．05。SAH组兔基底动脉组织ICAM-1mRNA的表达量高于对照组（0．843±0．029和0．673±0．011,P〈0．05）;给予辛伐他汀后,基底动脉ICAM-1mRNA的表达量低于SAH组（0．763±0．037）,与SAH组比较,P〈0．05。结论辛伐他汀可能通过抑制炎性反应从而预防SAH后CVS的发生,其抑制炎性反应,可能是通过NF—κB信号途径实现的。