Pharmacological treatment of delayed cerebral ischemia and vasospasm in subarachnoid hemorrhage 英文参考文献.docVIP

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Pharmacological treatment of delayed cerebral ischemia and vasospasm in subarachnoid hemorrhage 英文参考文献.doc

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Pharmacological treatment of delayed cerebral ischemia and vasospasm in subarachnoid hemorrhage 英文参考文献

Castanares-ZapateroandHantsonAnnalsofIntensiveCare2011,1:12 /content/1/1/12 REVIEW OpenAccess Pharmacologicaltreatmentofdelayedcerebral ischemiaandvasospasminsubarachnoid hemorrhage DiegoCastanares-ZapateroandPhilippeHantson* Abstract Subarachnoidhemorrhageaftertheruptureofacerebralaneurysmisthecauseof6%to8%ofallcerebrovascular accidentsinvolving10of100,000peopleeachyear.Despiteeffectivetreatmentoftheaneurysm,delayedcerebral ischemia(DCI)isobservedin30%ofpatients,withapeakonthetenthday,resultinginsignificantinfirmityand mortality.Cerebralvasospasmoccursinmorethanhalfofallpatientsandisrecognizedasthemaincauseof delayedcerebralischemiaaftersubarachnoidhemorrhage.Itstreatmentcompriseshemodynamicmanagement andendovascularprocedures.Todate,theonlydrugshowntobeefficaciousonboththeincidenceofvasospasm andpooroutcomeisnimodipine.Givenitsmodesteffects,newpharmacologicaltreatmentsarebeingdeveloped topreventandtreatDCI.Wereviewthedifferentdrugscurrentlybeingtested. Introduction blood flow (CBF) in the spastic arteries leads to DCI, Delayed cerebral ischemia (DCI) is a common and ser- whichmaydevelopintocerebralinfarction[7,12,13]. ious complication following subarachnoid hemorrhage Theetiologyofvasospasmiscomplexandstillpoorly (SAH) after ruptured cerebral aneurismal [1,2]. understood. Several factors have been shown to be Although this complication is at times reversible, it involved,suchasendothelialdysfunction,lossofautore- may develop into a cerebral infarction [3]. DCI occurs gulation, and a hypovolemic component leading to a in approximately 20% to 40% [4] of patients and is decrease in CBF [14-16]. At the acute phase, the pre- associated with increased mortality and poorprognosis sence of oxyhemoglobin in the subarachnoid spaces [5,6]. It is usually caused by a vasospasm [7], which, causes a local and systemic inflammatory reaction [17] although preventable, remains a major cause of poor withactivation ofplatelets andcoagulation [8-10]. The neurological outco