上海交通大学学报（医学版）

上海交通大学学报（医学版）

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蛛网膜下腔出血后迟发性脑缺血机制的研究进展

金珂 1, 2，吕涛 1, 2，金义超 1, 2，张晓华 1, 2   

  1. 上海交通大学 医学院1. 附属仁济医院神经外科，上海 200127；2. 附属仁济医院南院神经外科，上海 201112
  • 出版日期:2017-01-28 发布日期:2017-01-19
  • 通讯作者: 张晓华，电子信箱：zxh1969@aliyun.com。
  • 作者简介:金珂（1991—），男，硕士生；电子信箱：runningkiing@163.com。
  • 基金资助:

    国家自然科学基金（81471333）

Research advances on the mechanisms of delayed cerebral ischemia after subarachnoid hemorrhage

JIN Ke1, 2, Lü Tao1, 2, JIN Yi-chao1, 2, ZHANG Xiao-hua1, 2   

  1. 1. Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China;2. Department of Neurosurgery, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai 201112, China
  • Online:2017-01-28 Published:2017-01-19
  • Supported by:

    National Natural Science Foundation of China,81471333

PDF (PC)

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摘要：

脑血管痉挛传统上被视为蛛网膜下腔出血（SAH）后出现迟发性脑缺血的一个重要原因，并经常导致脑梗死和神经系统功能损伤，预后不良。近期研究认为，血管痉挛并不是引起迟发性缺血性并发症的唯一原因。调查结果发现，血管痉挛发生率的明显降低并没有使得迟发性脑缺血有所减少或预后有所改善，这促使研究方向转向了其他可能导致缺血性并发症的机制。早期的脑损伤、皮层扩散去极化、微血栓形成、微血管痉挛、脑血流自动调节失灵、细胞死亡、血脑屏障破坏和启动炎症级联反应都与迟发性脑缺血的发生有关。

关键词: 蛛网膜下腔出血, 脑血管痉挛, 迟发性脑缺血

Abstract:

Cerebral vasospasm is traditionally regarded as an important cause of delayed cerebral ischaemia which occurs after subarachnoid haemorrhage (SAH), and often leads to cerebral infarction, damaged nervous system function, and poor prognosis. However, recent studies suggest that vasospasm is not the sole cause of delayed ischaemic complications. Findings that marked reduction in the incidence of vasospasm does not lead to a reduction in delayed cerebral ischaemia or better outcomes have promoted researches on other possible mechanisms that may cause ischaemic complications. Early brain injury, cortical spreading depolarizations, microthrombosis, microvascular spasm, failure of cerebral blood flow autoregulation, cell death, blood-brain barrier disruption, and initiation of an inflammatory cascade are all associated with the incidence of delayed cerebral ischaemia.

Key words: subarachnoid hemorrhage, cerebral vasospasm, delayed cerebral ischaemia