Metamorphosis of subarachnoid hemorrhage research: from delayed vasospasm to early brain injury.
Metamorphosis of subarachnoid hemorrhage research: from delayed vasospasm to early brain injury.
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DOI：
10.1007/s12035-010-8155-z
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发表时间：
2011-02
影响因子：
5.1
通讯作者：
Zhang, John H.
中科院分区：
文献类型：
--
作者：
Sehba, Fatima A.;Pluta, Ryszard M.;Zhang, John H.
关键词：
蛛网膜下腔出血（SAH）后3-7天发生的迟发性血管痉挛传统上被认为是迟发性缺血性损伤和预后不良的最重要决定因素。因此，大多数针对迟发性缺血性损伤的治疗都是针对降低血管痉挛的发生率。然而，基于这种策略的临床试验迄今为止取得的成功有限;血管痉挛的发生率降低，但延迟性缺血性损伤没有减少，长期结局也没有改善。这一事实使研究兴趣转向SAH诱发的早期脑损伤（前72 h）。近年来，发现了几种在初次出血后几分钟内激活并导致早期脑损伤的病理机制。此外，研究发现，这些机制中的许多机制随着时间的推移而演变，并参与迟发性缺血损伤和不良结局的发病机制。因此，专注于这些早期机制的一种或多种疗法不仅可以预防早期脑损伤，而且还可以帮助降低后期神经系统并发症的强度。本文综述了SAH后早期脑损伤的病理机制，并总结了目前的治疗现状。
Delayed vasospasm that develops 3–7 days after aneurysmal subarachnoid hemorrhage (SAH) has traditionally been considered the most important determinant of delayed ischemic injury and poor outcome. Consequently, most therapies against delayed ischemic injury are directed towards reducing the incidence of vasospasm. The clinical trials based on this strategy, however, have so far claimed limited success; the incidence of vasospasm is reduced without reduction in delayed ischemic injury or improvement in the long-term outcome. This fact has shifted research interest to the early brain injury (first 72 h) evoked by SAH. In recent years, several pathological mechanisms that activate within minutes after the initial bleed and lead to early brain injury are identified. In addition, it is found that many of these mechanisms evolve with time and participate in the pathogenesis of delayed ischemic injury and poor outcome. Therefore, a therapy or therapies focused on these early mechanisms may not only prevent the early brain injury but may also help reduce the intensity of later developing neurological complications. This manuscript reviews the pathological mechanisms of early brain injury after SAH and summarizes the status of current therapies.
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