蛛网膜下腔出血后迟发性脑缺血的病理生理机制探讨

Discussions on Pathophysiological Mechanism of Delayed Cerebral Ischemia after Subarachnoid Hemorrhage

蛛网膜下腔出血(subarachnoid hemorrhage,SAH)是一种十分凶险的脑血管病,具有高死亡率、高致残率及高治疗难度的特点。迟发性脑缺血(delayedcerebralischemia,DCI)是SAH后一种常见的并发症,一旦发生将严重影响患者预后。因此,明确DCI的病理生理机制对其预防和治疗具有至关重要的作用。既往认为,脑血管痉挛是SAH后导致DCI的唯一原因,但近年来这一观点受到广泛质疑。目前认为DCI是一个由多种病理生理机制共同参与的复杂病理过程,本文旨在探讨DCI的病理生理机制,以期帮助找到早期识别DCI高风险人群的方法,探索新的防治方式,从而改善患者预后。

Subarachnoid hemorrhage(SAH),one of the most threatening cerebrovascular diseases,is characterized by high mortality and high disability rate,which is difficult to be treated.Delayed cerebral ischemia(DCI)is a common complication after SAH and is related to poor functional outcome.Thus,it is important to understand the pathophysiological mechanisms of DCI for preventing and treating DCI.Cerebral vasospasm was thought to be the only reason of DCI in the past,while this hypothesis has been widely questioned in the recent years.Studies have supported the notion of a multifactorial pathophysiological process of DCI.This review aimed to summarize the main pathophysiological mechanisms of DCI at present,to help to explore the methods of identifying the high-risk patients early and develop a novel therapeutic strategy.