关注神经重症患者迟发性脑缺血的治疗

Focusing on the treatments for delayed cerebral ischemia in neurocritical ill patients

迟发性脑缺血(delayed cerebral ischemia,DCI)是一种严重威胁重症患者生命安全的疾病,也是导致蛛网膜下腔出血后患者致残、致死的主要原因。但因患者神经功能损害严重、临床表现不明显、诊断困难等原因,不被临床医生重视。从强调宏观(血管痉挛)到注重微观(微循环障碍、自主调节功能受损等)的病理生理过程转变是理解DCI的基础;早期诊断及有效的治疗则是防治DCI的关键。文章通过复习文献,对DCI的定义、监测技术、治疗手段等做一阐述,探讨DCI的综合防治策略。

Delayed cerebral ischemia(DCI)is a disease that seriously threatens the lives of critically ill patients,which is a primary cause of disability and death in patients after subarachnoid hemorrhage(SAH).However,due to severe neurological damage and clinical manifestations being not obvious,and diagnosis being difficult,DCI is not paid attention to by clinicians.The basis for understanding DCI is the transition from emphasizing macroscopic(vasospasm) to microscopic(microcirculation disfunction,impaired autonomic regulation)in pathophysiological processes.Early diagnosis and effective treatment are the key to prevention and treatment of DCI.Through reviewing literatures,this article elaborates on the definition of DCI,monitoring techniques,and treatment methods,and discusses the integrated prevention and treatment strategies of DCI.