Management of subarachnoid haemorrhage

Subarachnoid haemorrhage is an acute life-threatening neurosurgical emergency affecting all ages and causing high mortality and morbidity. The rupture of an aneurysm of an intracranial artery at a point of turbulent blood flow within the circle of Willis usually causes it. Diagnosis begins with a non-contrast CT of the head, followed by more definitive angiography. The focus after diagnosis is to minimize further neurological injury called secondary injury. Initial stabilization with an ABCDEF approach should focus on maintaining adequate cerebral oxygenation and cerebral perfusion pressure (CPP). In emergent cases, this may require intubation and mechanical ventilation. Transfer to a specialist neuroscience centre for ongoing management is the next priority. Culprit aneurysms should be secured promptly by endovascular coiling or surgical clipping. Anaesthesia for either clipping or coiling must be neuroprotective. Recognition and management of complications are best undertaken in a centre managing high volumes of these patients. Vasospasm and delayed cerebral ischaemia are common and feared complications of subarachnoid haemorrhage. All patients should be given nimodipine for prophylaxis and management of these complications. Future research into the pathophysiology of the injured brain in SAH can guide us to novel therapies.     

蛛网膜下腔出血后鼠脑底动脉内皮素-1能神经纤维的表达变化

本文旨在探讨大鼠蛛网下腔出血(SAH)诱发脑血管痉挛时脑底动脉内皮素-1(endothelin-1,ET-1)能神经纤维的表达变化及其诱发脑血管痉挛的作用。大鼠随机分为正常组、SAH组(3d、14d)。SAH组大鼠取股动脉自体血注入蛛网膜下腔,应用免疫组织化学ABC法,观察正常组、SAH组大鼠脑底动脉ET-1能神经纤维的表达。结果显示正常组大鼠脑底动脉可见棕褐色,细线状ET-1能免疫反应阳性纤维。SAH后3d组大鼠脑底动脉与正常组大鼠脑底动脉比较ET-1能神经纤维密度明显增多,统计学检验(P<0.05);而SAH14d组大鼠脑底动脉ET-1能阳性神经纤维密度与正常组比较无明显变化。以上结果提示脑底动脉ET-1能神经纤维在蛛网膜下腔出血诱发脑血管痉挛的病理生理过程中可能发挥重要的作用。     

法舒地尔预防蛛网膜下腔出血后脑血管痉挛的效果观察

目的：观察应用法舒地尔对蛛网膜下腔出血后脑血管痉挛的疗效。方法：采用对照研究的方法,将蛛网膜下腔出血55例患者随机分成两组,治疗组28例,给予法舒地尔静点30 mg,每日q8 h静点1次,用药时间为14 d;对照组27例,给予尼莫地平10 mg静点,每小时0.5～1.0 mg的速度连续静点,每日1次,时间为14 d。通过观察两组临床表现的症状及体征、颅脑CT、Hunt＆Hess分级来评价临床疗效。结果：防治脑血管痉挛治疗组总有效率为100%（28/28）,对照组总有效率为81%（22/27）,经比较,治疗组的疗效明显优于对照组（P〈0.05）;对于血压的影响,治疗组轻于对照组。结论：为防治蛛网膜下腔出血后的脑血管痉挛,应用法舒地尔优于尼莫地平,且副作用较小。