CIRCUMSTANCES SURROUNDING ANEURYSMAL SUBARACHNOID HEMORRHAGE
CIRCUMSTANCES SURROUNDING ANEURYSMAL SUBARACHNOID HEMORRHAGE
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DOI：
10.1016/0090-3019(89)90228-0
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发表时间：
1989-10-01
影响因子：
--
通讯作者：
VANDERWERF, DJM
中科院分区：
文献类型：
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作者：
SCHIEVINK, WI;KAREMAKER, JM;VANDERWERF, DJM
研究人员对神经外科中心收治的 500 名连续患者进行了调查，了解动脉瘤性蛛网膜下腔出血的情况。 42.8%的患者发生应激事件时发生蛛网膜下腔出血，34.4%的患者发生在非剧烈活动期间，11.8%的患者发生在休息或睡眠期间。其余 11.0% 的人不知道蛛网膜下腔出血前的活动或事件。男性比女性更容易在压力事件中发生出血（54.1% vs 36.6%；p < 0.00025）。只有 30.1% 的颈内动脉瘤在应激事件中破裂，而其他部位的动脉瘤破裂的比例为 48.1% (p < 0.005)。讨论了对各种活动和事件的生理反应，因为它们可能与动脉瘤性蛛网膜下腔出血的机制有关。动脉瘤破裂发生的两个重要因素是动脉血压升高和动脉瘤周围脑脊液压力降低。这些因素导致高跨壁压力和伴随的壁应力。体力消耗、涉及瓦尔萨尔瓦动作的活动和情绪紧张都与血压升高有关，并且常常先于蛛网膜下腔出血。动脉瘤周围脑脊液压力的波动主要发生在瓦尔萨尔瓦动作和姿势改变过程中。
The circumstances surrounding aneurysmal subarachnoid hemorrhage were investigated in a group of 500 consecutive patients admitted to a neurosurgical center. Subarachnoid hemorrhage occurred during stressful events in 42.8% of the patients, during nonstrenuous activities in 34.4%, and during rest or sleep in 11.8%. The activities or events preceding subarachnoid hemorrhage were not known in the remaining 11.0%. Men were more likely to have suffered their hemorrhage during stressful events than women (54.1% versus 36.6%; p < 0.00025). Only 30.1% of aneurysms arising from the internal carotid artery ruptured during stressful events compared with 48.1% of aneurysms at other locations (p < 0.005). Physiological responses to the various activities and events are discussed as they may relate to mechanisms underlying aneurysmal subarachnoid hemorrhage. Two important factors in the precipitation of aneurysmal rupture are increased arterial blood pressure and decreased cerebrospinal fluid pressure around the aneurysm. These factors results in a high transmural pressure and concomitant wall stress. Physical exertion, activities involving the Valsalva maneuver, and emotional strain are associated with an increase in blood pressure and frequently preceded subarachnoid hemorrhage. Fluctuations in cerebrospinal fluid pressure around the aneurysm mainly occur during Valsalva''s maneuver and postural changes.