...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Neurosurgery >Reversal of severe cerebral vasospasm in three patients after aneurysmal subarachnoid hemorrhage: initial observations regarding the use of intraventricular sodium nitroprusside in humans.
【24h】

Reversal of severe cerebral vasospasm in three patients after aneurysmal subarachnoid hemorrhage: initial observations regarding the use of intraventricular sodium nitroprusside in humans.

机译：三例动脉瘤性蛛网膜下腔出血后严重脑血管痉挛的逆转：关于在人体内使用脑室内硝普钠的初步观察。

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

OBJECTIVE AND IMPORTANCE: The chronic delayed type of cerebral vasoconstriction that occurs after aneurysmal subarachnoid hemorrhage (SAH) is now the most important cause of mortality and neurological morbidity for patients who initially survive the rupture of cerebral aneurysms. Although intravascular volume expansion and cardiac performance enhancement have had a profound impact on the treatment of the chronic delayed type of cerebral vasoconstriction, this form of treatment is not tolerated by all patients and is unhelpful in some. A more specific and more reliable treatment for this condition has not been previously reported. Previous work in an animal model has demonstrated the efficacy of nitric oxide-donating compounds in reversing severe cerebral vasoconstriction when delivered to the adventitial side of the blood vessel. A clinical study was initiated after receiving approval from the United States Food and Drug Administration and the institutional review board. CLINICAL PRESENTATION: Three cases of prompt and substantial reversal of medically refractory vasospasm occurring after aneurysmal SAH in humans using an intrathecally administered nitric oxide donor and clinical, angiographic, and ultrasonographic documentation are presented. All patients developed severe vasospasm refractory to medical treatment 5 to 12 days after sustaining aneurysmal SAH. All patients manifested stupor of new onset (Glasgow Coma Scale score of 7) and new focal neurological deficit (hemiplegia). The condition was angiographically demonstrated in all cases. INTERVENTION: The patients were treated with intrathecally administered sodium nitroprusside, which caused the reversal of vasospasm, which was documented by angiography and transcranial Doppler ultrasonography up to 54 hours later and also by dramatic clinical improvement. Complications related to intracranial pressure elevation, changes in vital signs, and hemodynamic parameters were not observed during or after the procedures. Radiographic evidence of the reversal of vasospasm and brain ischemia was obtained. The clinical outcomes of the treated patients were excellent. All patients presented with hemiplegia and stupor that resolved or markedly improved (within several days, two patients; within 12 hours, one patient). All three patients were discharged and were living at home at the time of manuscript submission. CONCLUSION: These preliminary observations suggest that sodium nitroprusside delivered by an intrathecal route of administration may be a useful treatment for severe vasospasm complicating SAH in humans.
机译：目的和重要性：对于最初在脑动脉瘤破裂后幸存的患者，动脉瘤性蛛网膜下腔出血（SAH）后发生的慢性迟发性脑血管收缩现已成为死亡率和神经系统疾病的最重要原因。尽管血管内容量的增加和心脏功能的改善对慢性延迟型脑血管收缩的治疗产生了深远的影响，但并非所有患者都可以接受这种治疗方式，并且对某些患者无济于事。此前尚未报道过针对这种情况的更具体，更可靠的治疗方法。在动物模型中的先前工作已证明，当将一氧化氮供体化合物递送到血管的外膜侧后，可以逆转严重的脑血管收缩。获得美国食品和药物管理局和机构审查委员会的批准后，开始了一项临床研究。临床表现：提出了三例使用鞘内给药的一氧化氮供体并在临床，血管造影和超声检查方面证实的人的动脉瘤SAH后发生的医学上难治性血管痉挛的迅速，实质性逆转的案例。维持动脉瘤性SAH后5至12天，所有患者均出现严重的血管痉挛，难以接受药物治疗。所有患者均表现为木僵新发作（格拉斯哥昏迷量表评分为7）和新发局灶性神经功能缺损（偏瘫）。所有病例均经血管造影证实。干预：对患者进行鞘内注射硝普钠治疗，引起血管痉挛的逆转，血管造影和经颅多普勒超声检查可证实这种情况的发生长达54小时，而且临床效果也得到了显着改善。在手术期间或之后未观察到与颅内压升高，生命体征变化和血液动力学参数有关的并发症。获得了血管痉挛和脑缺血逆转的影像学证据。治疗的患者的临床结果非常好。所有出现偏瘫和木僵的患者均已缓解或明显好转（几天之内，两名患者;十二小时内，一名患者）。在提交手稿时，所有三名患者均已出院，并住在家里。结论：这些初步观察结果表明，鞘内给药途径输送的硝普钠可能是使人SAH严重的血管痉挛的有效方法。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号