动脉瘤性蛛网膜下腔出血预后的研究进展
Research Progress on the Prognosis of Aneurysmal Subarachnoid Hemorrhage
DOI: 10.12677/acm.2025.1541014, PDF,   
作者: 熊 韩, 何朝晖*：重庆医科大学附属第一医院，神经外科，重庆
关键词: 动脉瘤性蛛网膜下腔出血；预后；诊疗方案；Aneurysmal Subarachnoid Hemorrhage； Prognosis； Diagnosis and Treatment Plan
摘要: 动脉瘤性蛛网膜下腔出血(aSAH)是一种高致死、致残率的神经血管急症，其预后受患者基线特征、动脉瘤解剖特性、治疗策略及并发症等多因素动态影响。临床早期干预(如发病24小时内行动脉瘤栓塞或夹闭)不仅可以降低再出血率，还可改善患者预后，但仍需注重个体化治疗策略。并发症如早期脑损伤、迟发性脑缺血和慢性脑积水会增加患者不良预后风险。传统的评估工具(如Hunt-Hess评分、WFNS分级)具有对认知和生活质量评估不足的局限，而近红外光谱技术(NIRS)通过监测脑氧供需失衡提升早期预警能力，血清生物标志物(GFAP、NfL)联合机器学习模型(整合影像组学与临床数据)可提高预后预测的可靠度。当前研究面临的挑战包括治疗争议(血压管理目标、尼莫地平给药方式)、并发症机制不明(如脑积水、迟发性脑缺血)及长期认知功能数据匮乏。未来需通过多中心协作、精准医学策略及动态监测技术突破现有局限，实现个体化全周期管理，改善患者功能与生活质量。本文系统综述了aSAH的遗传和病理生理机制、临床表现、预后影响因素、预后评估及诊疗进展。
Abstract: Aneurysmal subarachnoid hemorrhage (aSAH) is a neurovascular emergency characterized by high mortality and disability rates. Patient prognosis is dynamically influenced by multiple factors, including baseline characteristics, aneurysm anatomical features, treatment strategies, and complications. Early clinical interventions, such as aneurysm embolization or surgical clipping within 24 hours of onset, not only reduce rebleeding rates but also improve outcomes, though individualized treatment strategies remain essential. Complications such as early brain injury, delayed cerebral ischemia (DCI), and chronic hydrocephalus significantly elevate the risk of poor prognosis. Traditional assessment tools (e.g., Hunt-Hess scale, World Federation of Neurological Societies [WFNS] grading) exhibit limitations in evaluating cognitive function and quality of life. In contrast, near-infrared spectroscopy (NIRS) enhances early warning capabilities by monitoring cerebral oxygen supply-demand imbalance, while serum biomarkers (e.g., GFAP, NfL) combined with machine learning models integrating radiomics and clinical data improve the reliability of prognostic predictions. Current research challenges include unresolved therapeutic controversies (e.g., optimal blood pressure management targets, routes of nimodipine administration), unclear mechanisms of complications (e.g., hydrocephalus, DCI), and insufficient long-term cognitive function data. Future advancements require multicenter collaboration, precision medicine strategies, and dynamic monitoring technologies to overcome existing limitations, enabling personalized whole-cycle management and improving functional outcomes and quality of life. This review systematically synthesizes the genetic and pathophysiological mechanisms, clinical manifestations, prognostic determinants, and recent advances in the diagnosis and treatment of aSAH.
文章引用：熊韩, 何朝晖. 动脉瘤性蛛网膜下腔出血预后的研究进展[J]. 临床医学进展, 2025, 15(4): 924-933. https://doi.org/10.12677/acm.2025.1541014

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