动脉瘤性蛛网膜下腔出血后脑血管痉挛和围术期容量治疗

Cerebral vasospasm and perioperative volume therapy in aneurysmal subarachnoid hemorrhage

背景动脉瘤破裂蛛网膜下腔出血后脑血管痉挛（cerebral vasospasm，CVS）是一个常见而严重的并发症。CVS造成的继发性脑组织缺血或迟发性脑损伤严重影响患者的预后，是动脉瘤性蛛网膜下腔出血（aneurysm subarachnoid hemorrhage，aSAH）患者伤残和死亡的主要因素。目的探究围术期液体治疗和循环容量管理在aSAH后CVS预防和治疗中的有效性，为减少脑动脉瘤手术后CVS发生、改善预后提供参考。内容探究动脉瘤破裂蛛网膜下腔出血后CVS病因、病理生理以及如何选择合适的液体进行容量治疗和三高疗法来防治CVS的发生。趋向深入研究脑动脉瘤破裂出血后CVS的发病机制和探讨围术期液体治疗以及循环容量管理，为临床防治CVS提供新的思路和方法。

Background Cerebral vasospasm （CVS） is a common and serious complication of aneurysmal subarachnoid hemorrhage. Secondary brain ischemia and damage following CVS are the main factors for patient bad outcome or high mortality. Objective The aim is to clarify the effect of prevention and treatment in the perioperative fluid therapy and circulating blood volume management for CVS and patient better outcome following aneurysmal subarachnoid hemorrhage. Content We＇ll review the etiology and pathophysiology of CVS following aneurysmal subarachnoid hemorrhage and how to prevent CVS by fluid therapy and triple-H therapy. Trend It might be helpful to make further researches in pathogenesis of CVS and how to prevent CVS by fluid therapy and circulating blood volume management.