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浙江大学学报(医学版)  2015, Vol. 44 Issue (4): 357-360    DOI: 10.3785/j.issn.1008-9292.2015.07.01
指南与实践     
动脉瘤性蛛网膜下腔出血诊治热点问题及展望
张建民
浙江大学医学院附属第二医院神经外科, 浙江 杭州 310009
Guidelines for diagnosis and management of aneurysmal subarachnoid hemorrhage: top issues and prospective
ZHANG Jian-min
Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
全文: PDF(663 KB)  
摘要: 

动脉瘤性蛛网膜下腔出血(aSAH)是一类致死率和致残率极高的出血性脑卒中.尽管aSAH临床术前诊断、术中治疗和术后重症监护等方面都获得了很大的进展,但aSAH患者的总体预后并无明显改善.2011年,美国神经危重症协会发布了aSAH患者重症医学处理的推荐意见;2012年,心脏病协会和美国卒中协会更新了2009年aSAH的诊治指南;2013年,欧洲卒中组织制定了欧洲颅内动脉瘤和aSAH诊疗指南;2014年,韩国神经介入学会发布了破裂和未破裂动脉瘤的治疗指南.2015年,中国医师协会神经外科专家委员会也发布了重症aSAH管理专家共识.可见,aSAH的诊治成为神经外科研究的重点和热点.本文总结上述指南中关于aSAH诊断和治疗方面的重点内容、新进展或更新,比较各种用于aSAH诊断的影像学检查的优缺点,探讨手术治疗和血管内治疗的适应证,以期提高aSAH诊治水平,改善患者的预后.

关键词 蛛网膜下腔出血/诊断蛛网膜下腔出血/治疗综述    
Abstract

Objective: Aneurysmal subarachnoid hemorrhage (aSAH) is a kind of hemorrhagic stroke with high mortality and morbidity. Although the preoperative diagnosis, surgical clipping, endovascular treatment, and intensive care have progressed in recent years, the overall prognosis of aSAH patients remains poor. In 2011, the Neurocritical Care Society organized an international, multidisciplinary consensus conference addressed the critical care management of SAH. In 2012, the American Stroke Association (AHA) updated the guidelines of diagnosis and treatment of aSAH published in 2009. In 2013, European Stroke Organization established the guideline for management of intracranial aneurysms and SAH. In 2014, the Korean Society of Interventional Neuroradiology (KSIN) published clinical practice guideline for the management of ruptured and unruptured aneurysms. The guideline for diagnosis and management of aSAH for Chinese patients has been drafted in this year. Thus, the diagnosis and management of aSAH is a hot topic in neurosurgery. This editorial summarizes the above mentioned guidelines and focuses on the progress and update of these guidelines. In this article we discuss the advantage and disadvantage of those imaging techniques, the pros and cons of surgical clipping and endovascular treatment.

Key wordsSubarachnoid hemorrhage/diagnosis    Subarachnoid hemorrhage/therapy    Review
收稿日期: 2015-02-06
CLC:  R741  
基金资助:

国家自然科学基金(81171096,81371433)

作者简介: 张建民(1959-),男,博士,主任医师,教授,博士生导师,主要从事脑卒中的基础和临床研究;E-mail:zjm135@vip.sina.com;http://orcid.org/0000-0003-1878-8388
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引用本文:

张建民. 动脉瘤性蛛网膜下腔出血诊治热点问题及展望[J]. 浙江大学学报(医学版), 2015, 44(4): 357-360.
ZHANG Jian-min. Guidelines for diagnosis and management of aneurysmal subarachnoid hemorrhage: top issues and prospective. Journal of ZheJiang University(Medical Science), 2015, 44(4): 357-360.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2015.07.01      或      http://www.zjujournals.com/xueshu/med/CN/Y2015/V44/I4/357

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