动脉瘤性蛛网膜下腔出血后神经元损伤机制的研究进展

Recent progress of the neural injury mechanism after aneurysmal subarachnoid hemorrhage

动脉瘤性蛛网膜下腔出血(aSAH)是脑卒中最严重的表现形式之一。颅内动脉瘤破裂后血液瘀滞在脑蛛网膜下腔,引起多种病理生理改变,包括脑积水、细胞凋亡、血脑屏障功能障碍、血管痉挛、微血栓形成和皮层扩散性抑制,这些机制相互作用并贯穿于整个脑损伤过程。近年来,临床试验逐渐关注a SAH发生后的两个阶段:早期脑损伤(EBI)和延迟性脑缺血(DCI)。这两个时期是导致神经元损伤的主要阶段,并与患者的预后密切相关。我们就近年来蛛网膜下腔出血后脑损伤的机制作一简要总结,主要讨论EBI和DCI在神经损伤中的作用。

Aneurysmal subarachnoid hemorrhage(aSAH)is one of the most devastating form of stroke.Many physiopathology mechanisms ensue after cerebral aneurysm rupture with blood silting up in the subarachnoid space,including hydrocephalus,cell apoptosis,blood-brain barrier dysfunction,macrovascular vasospasm,microthrombosis and cortical spreading depolarization which interact with each other and work throughout the damage process.Recently,clinical trials gradually pay more attention to two phases of injury after aS AH:the early phase known as early brain injury(EBI)and the delayed phase,delayed cerebral ischemia(DCI).These two phases are main processes accounting for neural injury and are thought to be closely linked with the outcomes of the patients.This review makes a brief summary on the mechanism of cerebral injury after aS AH,mostly on EBI and DCI.