蛛网膜下腔出血患者不同时期脑脊液中一氧化氮浓度的变化

目的：研究动脉瘤性蛛网膜下腔出血后患者不同时期脑脊液中一氧化氮（NO）浓度的动态变化及其与脑血管痉挛的关系。方法：采集52例破裂动脉瘤患者脑脊液标本，采集时间为入院后即刻，出血后第3，5，7，10，14天，采用镉粒还原法检测脑脊液中NO浓度，结果：出血后第3天脑脊液中NO浓度即有明显降低，在出血后第7天达到最低，而后逐渐升高，症状性脑血管痉挛患者NO浓度明显低于未痉挛者及无症状的血管痉挛患者，结论：症状性脑血管痉挛的发生与脑脊液中NO浓度降低有关。     

颅内动脉瘤出血患者脑脊液和血液NO、NOS和ET含量的变化

目的：研究动脉瘤性蛛网膜下腔出血后患者脑脊液和血液中内皮素-1（ET-1）、一氧化氯（NO）和一氧化氮合成酶（NOS）含量的动态变化及与脑血管痉挛的关系。方法：检测22例颅内动脉瘤破裂蛛网膜下腔出血患者不同时间段的脑脊液和血液中ET-1、NO和NOS的含量。结果：出血后患者脑脊液和血液中ET-1浓度即有明显升高，在出血后第7天达到高峰，而后逐渐下降。脑血管痉挛患者ET-1浓度明显高于未痉挛者。出血后NO、NOS的含量明显下降，14d时大部恢复至正常。结论：脑脊液和血液中ET-1、NO和NOS含量的变化参与蛛网膜下腔出血后脑血管痉挛的发生。     

蛛网膜下腔出血患者血浆肿瘤坏死因子-α和内皮素含量动态变化及其临床意义

目的 观察蛛网膜下腔出血患者血浆中肿瘤坏死因子-α(TNF-α)及内皮素(ET)水平的动态变化.方法 采用ELISA法和放免法分别测定45例蛛网膜下腔出血患者第1、3、7、14、21天的血浆TNF-α和ET水平.结果 蛛网膜下腔出血患者血浆TNF-α和ET水平较正常对照组高(均P<0.01),第3～7天升高明显,第14天降低,但第21天仍高于对照组.Hunt-Hess分级Ⅲ～Ⅴ级患者第3、14、21天血浆TNF-α和ET均较Ⅰ、Ⅱ级者高(P<0.01).结论 TNF-α和ET作为免疫因素参与了蛛网膜下腔出血的病理生理过程,提示TNF-α和ET拮抗剂治疗蛛网膜下腔出血及预防其所致脑血管痉挛将是一条可能途径.     

动脉瘤性蛛网膜下腔出血患者脑脊液垂体激素含量变化的临床研究

目的 研究动脉瘤性蛛网膜下腔出血（SAH）患者脑脊液（CSF）促肾上腺皮质激素（ACTH）、促甲状腺激素（TSH）、卵泡刺激素（FSH）、黄体生成素（LH）、泌乳素（PRL）、生长激素（GH）浓度的动态变化规律。方法对40例动脉瘤性蛛网膜下腔出血患者发病后1～3d、7～9d、13～15d脑脊液ACTH、TSH、FSH、LH、PRL、GH的含量进行动态检测,用TCD检测大脑中动脉血流速度（VMCA）。结果动脉瘤性蛛网膜下腔出血患者CSF中ACTH、TSH、FSH、LH、PRL、GH在发病后1～3d．7～9d各均值明显高于对照组,尤以发病后7—9d变化明显;术前、术后有脑血管痉挛组和非脑血管痉挛组也有明显差异。结论动脉瘤性蛛网膜下腔出血患者脑脊液ACTH、TSH、FSH、LH、GH、PRL含量与病情演变、脑血管痉挛（CVS）程度有关,并可判断预后。     

1-磷酸鞘胺醇与动脉瘤性蛛网膜下腔出血后脑血管痉挛的相关性研究

目的：探讨1-磷酸鞘胺醇（S1P）与颅内动脉瘤破裂所致的自发性蛛网膜下腔出血（SAH）后脑血管痉 挛的相关性。方法：纳入部分动脉瘤破裂所致自发性SAH患者37例,分别在发病后第3、5、7、10、14天行 TCD检测跟踪血管痉挛程度,其中27例纳入痉挛组,10例纳入无痉挛组。另选取我院收治未破裂颅内动脉 瘤介入栓塞治愈术后半年复诊患者中,未见血管痉挛及血管狭窄的患者12例为对照组。采用高效液相色 谱法测定3组患者血清及脑脊液的S1P 水平。结果：与无痉挛组和对照组相比,痉挛组患者发病后3 d患者 血清和脑脊液中S1P 浓度升高,5 d时显著升高,至第7天达到高峰,至第14天时降至无明显差异。发病后 第7天,痉挛组患者大脑中动脉流速增加与血清和脑脊液中S1P 的浓度呈正相关（P＜0.05）。结论：SAH后 脑血管痉挛患者大脑中动脉流速明显增加,同时其血清及脑脊液中S1P 显著升高。     

腰大池持续引流不同时期犬脑脊液内皮素、一氧化氮变化与脑血管痉挛的关系

目的:观察腰大池持续引流的不同时期,犬症状性蛛网膜下腔出血后脑脊液中内皮细胞衍生性血管收缩因子内皮素和内皮细胞衍生性血管舒张因子一氧化氮的变化与脑血管痉挛的关系。方法:实验于2004-05/2004-10在武汉总医院实验中心完成,取普通级成年健康家犬20只,雌雄不拘,体质量12～22kg,平均15kg。采用二次注血法建立犬症状性蛛网膜下腔出血模型,完全随机分组,引流组10只,蛛网膜下腔出血模型行腰大池持续引流脑脊液14d,每日引流100mL左右;腰穿组10只,即对照组,1次/d腰穿,抽取脑脊液8～10mL。测定蛛网膜下腔出血后腰大池持续引流前后不同时期,脑脊液中内皮素和一氧化氮浓度,观察内皮素和一氧化氮浓度动态变化,同时应用经颅彩色多普勒超声观察犬症状性蛛网膜下腔出血模型不同时期脑动脉血液流速,根据基底动脉平均流速判断和评价脑血管痉挛程度。结果:①脑脊液中血管收缩因子内皮素的变化:犬蛛网膜下腔出血后,脑脊液中内皮素浓度均有明显增高,第7天达到高峰,且腰穿组较引流组升高明显[(57.95±17.95),(34.15±7.19)ng/L,t=6.108,P<0.01];②脑脊液中血管舒张因子一氧化氮浓度的变化:出血后第3,7,10天两组脑脊液中一氧化氮浓度均下降,腰穿组较引流组下降明显[(1.20±0.25,1.20±0.25);(2.29±1.43,1.02±0.29);(3.26±1.43,0.88±0.28)μmol/L;t=15.624,P<0.01]。③两组基底动脉平均血流速度的变化:腰穿组蛛网膜下腔出血后第7,10天基底动脉平均流速比出血前和出血后3d明显增高[(39.67±14.76),(38.97±9.76),(10.97±4.85),(18.68±13.55)cm/s,t=8.231,P<0.01],引流组蛛网膜下腔出血后第7天基底动脉平均流速与出血前和出血后第3天比较无明显增高[(15.15±4.83),(13.59±4.64),(10.89±3.67)cm/s,t=1.879,P>0.05];基底动脉出现平均流速>40cm/s的重度脑血管痉挛时,脑血流出现涡流或湍流。④相关因素分析结果:脑脊液中内皮素浓度变化与基底动脉平均流速呈正相关(r=0.95),一氧化氮浓度变化与基底动脉平均流速呈负相关(r=-0.97)。结论:①蛛网膜下腔出血后内皮素与一氧化氮平衡破坏是引起迟发性脑血管痉挛关键因素之一。②引流组犬的脑血管痉挛程度较轻,而腰穿组脑血管痉挛程度较重,原因在于腰大池持续引流加速了内皮素和抑制一氧化氮合成酶的氧合血红蛋白的排出,缩短了脑血管痉挛持续时间,降低了脑血管痉挛的程度,证明蛛网膜下腔出血后腰大池持续引流的有效性和可行性。     

动脉瘤性蛛网膜下腔出血患者脑脊液白细胞介素-6水平研究

目的 探讨动脉瘤性蛛网膜下腔出血(SAH)患者脑脊液白细胞介素6(IL-6)水平变化及临床 意义.方法 45 例动脉瘤性SAH 患者,均行开颅动脉瘤夹闭治疗,其中23 例术后腰大池置管或脑室置管外 引流术并注入尿激酶治疗,22 例术后间断腰穿治疗,所有的45 例患者均常规尼莫地平治疗.此45 例患者和 对照组10 例患者均收集治疗后1 ～3 d、5 ～7 d、9 ～11 d、13 ～15 d 的脑脊液标本,对脑脊液IL-6 水平进行动 态测定,并观察其疗效和脑血管痉挛的情况.结果 动脉瘤性蛛网膜下腔出血患者脑脊液IL-6 显著高于正 常脑脊液水平,5 ～7 d 达高峰值,发病后不同时期各均值变化明显(P <0.05),IL-6 的升高与病情轻重和出血 量及脑血管痉挛有明显的关系,早期的脑脊液引流治疗可使IL-6 水平下降趋势明显.结论 IL-6可作为观 察病情及脑血管痉挛的指标,早期检测脑脊液中IL-6 水平可为指导治疗及预测预后提供依据,试验证实早期 血性脑脊液外引流是预防脑血管痉挛的有效措施.     

腰大池持续引流不同时期犬脑脊液内皮素、一氧化氮变化与脑血管痉挛的关系

目的：观察腰大池持续引流的不同时期，犬症状性蛛网膜下腔出血后脑脊液中内皮细胞衍生性血管收缩因子内皮素和内皮细胞衍生性血管舒张因子一氧化氮的变化与脑血管痉挛的关系。方法：实验于2004—05／2004—10在武汉总医院实验中心完成，取普通级成年健康家犬20只，雌雄不拘，体质量12～22kg，平均15kg。采用二次注血法建立犬症状性蛛网膜下腔出血模型，完全随机分组，引流组10只，蛛网膜下腔出血模型行腰大池持续引流脑脊液14d，每日引流100mL左右；腰穿组10只，即对照组，1次／d腰穿，抽取脑脊液8～10mL。测定蛛网膜下腔出血后腰大池持续引流前后不同时期，脑脊液中内皮素和一氧化氮浓度，观察内皮素和一氧化氮浓度动态变化，同时应用经颅彩色多普勒超声观察犬症状性蛛网膜下腔出血模型不同时期脑动脉血液流速，根据基底动脉平均流速判断和评价脑血管痉挛程度。结果：①脑脊液中血管收缩因子内皮素的变化：犬蛛网膜下腔出血后，脑脊液中内皮素浓度均有明显增高，第7天达到高峰，且腰穿组较引流组升高明显[（57．95&;#177;17．95），（34．15&;#177;7．19）ng／L，t=6．108，P〈0．01]；②脑脊液中血管舒张因子一氧化氮浓度的变化：出血后第3，7，10天两组脑脊液中一氧化氮浓度均下降，腰穿组较引流组下降明显[（1．20&;#177;0．25，1．20&;#177;0．25）；（2．29&;#177;1．43，1．02&;#177;0．29）；（3．26&;#177;1．43，0．88&;#177;0．28）μmol／L：t=15．624，P〈0．01]。③两组基底动脉平均血流速度的变化：腰穿组蛛网膜下腔出血后第7，10天基底动脉平均流速比出血前和出血后3d明显增高[（39．67&;#177;14．76），（38．97&;#177;9．76），（10．97&;#177;4．85），（18．68&;#177;13．55）cm／s，t=8．231，P〈0．01]，引流组蛛网膜下腔出血后第7天基底动脉平均流速与出血前和出血后第3天比较无明显增高[（15．15&;#177;4．83），（13．59&;#177;4．64），（10．89&;#177;3．67）cm／s，t=1．879，P〉0．051；基底动脉出现平均流速〉40cm／s的重度脑血管痉挛时，脑血流出现涡流或湍流。④相关因素分析结果：脑脊液中内皮素浓度变化与基底动脉平均流速呈正相关（r=0．95），一氧化氮浓度变化与基底动脉平均流速呈负相关（r=-0．97）。结论：①蛛网膜下腔出血后内皮素与一氧化氮平衡破坏是引起迟发性脑血管痉挛关键因素之一。②引流组犬的脑血管痉挛程度较轻，而腰穿组脑血管痉挛程度较重，原因在于腰大池持续引流加速了内皮素和抑制一氧化氮合成酶的氧合血红蛋白的排出，缩短了脑血管痉挛持续时间，降低了脑血管痉挛的程度，证明蛛网膜下腔出血后腰大池持续引流的有效性和可行性。     

颅内动脉瘤破裂出血患者血清FSH、LH的动态变化

目的 测定颅内动脉瘤破裂出血患者血清卵泡刺激素(FSH)、黄体生成素(LH)含量变化，探讨其与病情演变的关系。方法 对35例颅内动脉瘤破裂出血病人发病后l一3天、发病后7—9天、发病后13一15天血清FSH、LH进行动态观察，用TCD检测大脑中动脉血流速度(VMCA)。结果 颅内动脉瘤破裂出血患者血清FSH、LH发病后l一3天、发病后7—9天各均值明显高于对照组，尤以发病后7—9天变化最明显；术前、术后有脑血管痉挛组和非脑血管痉挛组也有明显差异。结论 血清FSH、LH含量与蛛网膜下腔出血(SAH)的病情演变、脑血管痉挛(CVS)有关。     

炎症与Hunt-Hess Ⅳ～Ⅴ级动脉瘤性蛛网膜下腔出血患者预后的相关性

目的探讨Hunt-HessⅣ~Ⅴ级动脉瘤性蛛网膜下腔出血患者预后的影响因素。方法 Hunt-HessⅣ、Ⅴ级动脉瘤性蛛网膜下腔出血患者49例,分析不同预后患者临床特征以及血液、脑脊液炎症相关指标的差异,并运用Logistic回归分析进行预后影响因素筛选。结果动脉瘤治疗方式、手术时机、Fisher分级、术后并发症等临床特征可能与患者预后相关(P0.05);不同预后患者住院第1、3、7天的白细胞计数比较差异有统计学意义(P0.05);不同预后患者C反应蛋白(CRP)水平存在差异,但不随时间变化而变化;首次脑脊液总蛋白、IgG含量存在差异(P0.05);Logistic回归分析结果显示7天血白细胞计数、脑脊液IgG、3天CRP水平、治疗方式、Fisher分级、术后并发症可能影响了患者的预后(P0.05)。结论除治疗方式、Fisher分级、术后并发症等相关影响因素外,炎症反应可能与Hunt-HessⅣ~Ⅴ级动脉瘤性蛛网膜下腔出血患者的预后相关。     

Cerebrovascular dynamics with head-of-bed elevation in patients with mild or moderate vasospasm after aneurysmal subarachnoid hemorrhage.

BACKGROUND: In patients with aneurysmal subarachnoid hemorrhage, elevation of the head of the bed during vasospasm has been limited in an attempt to minimize vasospasm or its sequelae or both. Consequently, some patients have remained on bed rest for weeks. OBJECTIVES: To determine how elevations of the head of the bed of 20 degrees and 45 degrees affect cerebrovascular dynamics in adult patients with mild or moderate vasospasm after aneurysmal subarachnoid hemorrhage and to describe the response of mild or moderate vasospasm to head-of-bed elevations of 20 degrees and 45 degrees with respect to variables such as grade of subarachnoid hemorrhage and degree of vasospasm. METHODS: A within-patient repeated-measures design was used. The head of the bed was positioned in the sequence of 0 degrees -20 degrees -45 degrees -0 degrees in 20 patients with mild or moderate vasospasm between days 3 and 14 after aneurysmal subarachnoid hemorrhage. Continuous transcranial Doppler recordings were obtained for 2 to 5 minutes after allowing approximately 2 minutes for stabilization in each position. RESULTS: No patterns or trends indicated that having the head of the bed elevated increases vasospasm. As a group, there were no significant differences within patients at the different positions of the head of the bed. Utilizing repeated-measures analysis of variance, P values ranged from .34 to .97, well beyond .05. No neurological deterioration occurred. CONCLUSIONS: In general, elevation of the head of the bed did not cause harmful changes in cerebral blood flow related to vasospasm.     

法舒地尔防治动脉瘤介入栓塞术后脑血管痉挛的疗效观察

【目的】探讨盐酸法舒地尔防治颅内动脉瘤破裂蛛网膜下腔出血（SAH）介入栓塞术后脑血管痉挛（CVS）的效果。【方法】将60例脑动脉瘤破裂SAH介入栓塞术后患者随机分为治疗组和对照组各30例,治疗组术后给予法舒地尔30mg静脉滴注q8h,疗程14d,每次静脉滴注时间为30min;对照组30例,术后采用尼莫地平,1mg／h,静脉泵入,疗程14d,比较两组的Glasgow评分,头部CT及经颅多普勒（TCD）观察大脑中动脉（MCA）血流速度的变化。【结果】法舒地尔与尼莫地平均可迅速促进疾病的好转;对CT检查所见脑内低密度灶,法舒地尔与尼莫地平均可使其改善;法舒地尔与尼莫地平扩张痉挛脑动脉的作用较好,两者无显著性差异（P〉0．05）。【结论】法舒地尔与尼莫地平均是预防和治疗动脉瘤破裂SAH介入栓塞术后CVS安全有效的药物。     

The use of heart rate variability for the early detection of treatable complications after aneurysmal subarachnoid hemorrhage

High-grade aneurysmal subarachnoid hemorrhage patients are monitored in the ICU for up to 21 days, as they are at risk for complications such as vasospasm of cerebral arteries, cardiac arrhythmias and neurogenic stress cardiomyopathy. The diagnosis of these treatable complications is often delayed by the limitations of monitoring capabilities. We applied computational analysis to a cohort of 24 aneurysmal subarachnoid hemorrhage patients, to identify heart rate variability and ECG frequency profiles that may be potential biomarkers of severe vasospasm, reversible cardiomyopathy and death.     

脑室持续外引流术治疗蛛网膜下腔出血的临床研究

目的 前瞻性研究脑室持续外引流治疗蛛网膜下腔出血的临床疗效。方法 治疗组病人（26例）行颅骨钻孔侧脑室内置管持续外引流3d，对照组（30例）为内科保守治疗的病人。结果 治疗组无一例死亡，对照组死亡4例（13％）。治疗组脑积水与脑血管痉挛的发生率为3．8％，对照组脑积水与脑血管痉挛的发生率分别为13％和20％，治疗组疗效明显优于对照组。结论 脑室待续外引流可应用于临床治疗蛛网膜下腔出血。     

Symptomatic vasospasm diagnosis after subarachnoid hemorrhage: evaluation of transcranial Doppler ultrasound and cerebral angiography as related to compromised vascular distribution

OBJECTIVE: To evaluate the reliability of transcranial Doppler ultrasound in detecting symptomatic vasospasm in patients after aneurysmal subarachnoid hemorrhage and monitoring response after hypertensive and endovascular treatments. DESIGN: Retrospective chart review. SETTING: Neurosciences critical care unit in a tertiary-care university hospital. PATIENTS: All patients admitted to a neurosciences critical care unit with the diagnosis of subarachnoid hemorrhage between January 1990 and June 1997. INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: We reviewed transcranial Doppler ultrasound data of 199 patients; 55 had symptomatic vasospasm. Clinical symptoms and corresponding vascular distributions were identified, as was angiographic vasospasm (n = 35). The sensitivity and specificity of transcranial Doppler ultrasound for anterior circulation vessels were calculated by using a mean cerebral blood flow velocity criterion of >120 cm/sec. Clinical diagnosis of symptomatic vasospasm was used as the standard to determine sensitivity and specificity of transcranial Doppler ultrasound and cerebral angiography. The sensitivity of transcranial Doppler ultrasound for anterior circulation in patients with symptomatic vasospasm was 73% with a specificity of 80%. The sensitivity of cerebral angiography was 80%. For individual vessels, the sensitivity and specificity of transcranial Doppler ultrasound were middle cerebral artery, 64% and 78%; anterior cerebral artery, 45% and 84%; and internal carotid artery, 80% and 77%, respectively. The mean times for symptomatic and transcranial Doppler ultrasound signs of vasospasm presentation were 6.4 +/- 2 and 6.1 +/- 3 days, respectively. In patients without symptomatic vasospasm, the mean time for mean cerebral blood flow velocities >120 cm/sec was 7.0 +/- 3 days (p <.05). Symptomatic vasospasm also was associated with thickness of clot on head computed tomography scan and rapidly increasing mean cerebral blood flow velocities. Transcranial Doppler ultrasound signs of vasospasm improved after endovascular treatment in 30 patients. CONCLUSIONS: The reliability of transcranial Doppler ultrasound was better at detecting high mean cerebral blood flow velocities in patients with symptomatic vasospasm related to middle cerebral and internal carotid artery distributions than for anterior cerebral artery distribution. Transcranial Doppler ultrasound was as sensitive as cerebral angiography at detecting symptomatic vasospasm. High mean cerebral blood flow velocities can be apparent before the presence of symptomatic vasospasm. Daily transcranial Doppler ultrasound monitoring could provide early identification of patients with aneurysmal subarachnoid hemorrhage who are at high risk for symptomatic vasospasm and may be helpful at following success of endovascular treatment.     

颅内动脉瘤介入治疗术后腰池引流和间断腰穿防治脑血管痉挛的临床疗效比较

【目的】比较颅内动脉瘤（AN）介入治疗后腰池引流和间断腰穿防治脑血管痉挛（CVS）的疗效。【方法】对40例Hunt—Hess分级相同的AN破裂出血病例按血管内治疗术后行持续蛛网膜下腔引流和间断腰穿释放脑脊液（CSF）分A、B两组,比较两组不同时间点相关指标。【结果】A组大脑中动脉流速（VMCA）明显低于B组且下降速度较快。A组CSF中RBC数目各时段均值明显低于B组,A组下降速率快于B组（均P〈0．05）;两组CSF中内皮素－1（ET－1）浓度在术后d3无显著性差异,其余各时间点均有显著性（P〈0．05）,A组的下降速率明显高于B组;术后14d神经功能缺损程度评分及评分减少程度的比较有显著性（P〈0．05）。【结论】AN破裂介入治疗术后持续腰池引流疗效优于间断腰椎穿刺,是防治CVS的首选方式。     

Copeptin in aneurysmal subarachnoid hemorrhage

Copeptin is a peptide derived from pre-provasospression along with arginine vasospressin. In the setting of aneurysmal subarachnoid hemorrhage (SAH), elevated serum copeptin levels correlate with vasospasm, inpatient mortality, mortality at 1 year, and poor functional outcome at 1 year. The potential role of serum copeptin levels in the management of patients with aneurysmal SAH is promising and should be explored further.     

The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage

OBJECTIVES. To examine the accuracy of transcranial Doppler to detect cerebral vasospasm in a patient population with aneurysmal subarachnoid hemorrhage. DESIGN. Prospective blind comparison of transcranial Doppler with cerebral angiography. Diagnostic accuracy of transcranial Doppler was assessed using receiver operating characteristic (ROC) analysis and likelihood ratios. Sensitivity and specificity were calculated using directly measured middle cerebral artery diameter as reference standard. SETTING. Intensive Care Unit of a large university teaching hospital. PATIENTS AND PARTICIPANTS. Twenty-two patients with subarachnoid hemorrhage were included. Patients underwent angiography on admission and after 8 days to diagnose vasospasm and were defined as having clinical vasospasm, angiographic vasospasm, or no vasospasm. MEASUREMENTS AND RESULTS. Sensitivity and specificity were 1.00 and 0.75 for angiographic vasospasm and both equal to 1.00 for clinical vasospasm diagnosis. A transcranial Doppler mean velocity threshold value of 100 cm/s for angiographic vasospasm and 160 cm/s for clinical vasospasm detection were chosen by ROC analysis. CONCLUSIONS. A Transcranial Doppler mean velocity threshold of 160 cm/s, calculated by the ROC analysis, accurately detects clinical vasospasm. A daily transcranial Doppler examination performed by a trained operator should be routinely used to provide early identification of patients at high risk and to orient therapeutic decisions.     

蛛网膜下腔出血后血浆NO和ET1浓度变化与发生CVS关系探讨

目的探讨蛛网膜下腔出血（SAH）后不同时期血浆一氧化氮（NO）、内皮素1（ETl）浓度的变化及其与SAH后脑血管痉挛（CVS）发生之间的关系。方法测定SAH患者不同时期ET1和NO的含量,计算ET1／NO值。并与健康对照组血浆ET1和NO的含量相比较。结果SAH后ET1水平显著升高,并在3-4d内维持较高水平;NO在SAH后下降明显。3d后才慢慢回升;ET1／NO值SAH后明显减低,而后慢慢回升。SAH各组ET1、NO、ET1／NO与对照组比较,差异均具有非常显著性（P〈0．01）。结论SAH后ET1／NO动态失衡,这一动态失衡在SAH后发生脑血管痉挛过程中起着非常重要的作用。