Treatment of Subarachnoid Hemorrhage-associated Delayed Cerebral Ischemia With Milrinone: A Review and Proposal.
Treatment of Subarachnoid Hemorrhage-associated Delayed Cerebral Ischemia With Milrinone: A Review and Proposal.
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DOI：
10.1097/ana.0000000000000755
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发表时间：
2021-07-01
影响因子：
3.7
通讯作者：
Angle MR
中科院分区：
文献类型：
--
作者：
Bernier TD;Schontz MJ;Izzy S;Chung DY;Nelson SE;Leslie-Mazwi TM;Henderson GV;Dasenbrock H;Patel N;Aziz-Sultan MA;Feske S;Du R;Abulhasan YB;Angle MR
动脉瘤性蛛网膜下腔出血后的延迟性脑缺血（DCI）仍然与高发病率和死亡率相关。这种并发症长期以来被认为是继发于严重的脑血管痉挛，但专家意见现在倾向于多因素病因，开辟了新疗法的可能性。迄今为止，没有明确的DCI治疗方案被推荐为标准治疗，这突出表明需要进一步研究潜在的治疗方法。米力农被认为是一种很有前景的DCI治疗药物，具有逆转脑血管痉挛的作用机制，以及潜在的抗炎作用，可以治疗DCI的潜在病因。在单中心病例系列和队列中，已经对米力农动脉和静脉给药治疗DCI进行了评估，结果显示是安全的，并与改善的临床结果相关。最近的结果也引起了人们对米力农早期、更积极的给药和滴定的潜在疗效的关注。然而，现有数据存在局限性，并且对于在更广泛的DCI患者中推广结果的问题仍然存在。需要为DCI中米林酮的使用制定标准化方案，具体解决需要进一步澄清的领域。标准化方案产生的数据可能为多中心随机对照试验提供动力。我们回顾了目前关于米力农治疗DCI的文献，并提出了一个初步的标准化方案，以进一步评估米力农的安全性和有效性。
Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage continues to be associated with high levels of morbidity and mortality. This complication had long been thought to occur secondary to severe cerebral vasospasm, but expert opinion now favors a multi-factorial etiology, opening the possibility of new therapies. To date, no definitive treatment option for DCI has been recommended as standard of care, highlighting a need for further research into potential therapies. Milrinone has been identified as a promising therapeutic agent for DCI, possessing a mechanism of action for the reversal of cerebral vasospasm as well as potentially anti-inflammatory effects to treat the underlying etiology of DCI. Intra-arterial and intravenous administration of milrinone has been evaluated for the treatment of DCI in single center case series and cohorts and appears safe and associated with improved clinical outcomes. Recent results have also brought attention to the potential outcome benefits of early, more aggressive dosing and titration of milrinone. Limitations exist within the available data, however, and questions remain about the generalizability of results across a broader spectrum of patients suffering from DCI. The development of a standardized protocol for milrinone use in DCI, specifically addressing areas requiring further clarification, is needed. Data generated from a standardized protocol may provide the impetus for a multi-center, randomized control trial. We review the current literature on milrinone for the treatment of DCI and propose a preliminary standardized protocol for further evaluation of both safety and efficacy of milrinone.