动脉瘤性蛛网膜下腔出血围手术期血压管理 综述
Review of Perioperative Blood Pressure Management in Aneurysmal Subarachnoid Hemorrhage
摘要: 蛛网膜下腔出血(Subarachnoid Hemorrhage, SAH)是一种严重的临床综合征，具有较高的致残率和死亡率，其中动脉瘤性蛛网膜下腔出血(Aneurysmal Subarachnoid Hemorrhage, aSAH)为最主要的类型。aSAH围手术期血压管理对于改善患者预后至关重要。本文综述了aSAH围手术期血压管理的当前研究进展，包括血aSAH相关病理生理机制、血压管理的目标、血压管理方法以及不同血压管理策略的效果等方面。通过对现有研究的综合分析，探讨合理的血压管理策略及其对患者预后的影响，寻求未来进一步研究方向，为临床医生在蛛网膜下腔出血围手术期的血压管理提供参考。
Abstract: Subarachnoid hemorrhage (SAH) is a severe clinical syndrome characterized by high disability and mortality rates, with aneurysmal subarachnoid hemorrhage (aSAH) being the predominant subtype. Perioperative blood pressure management in aSAH is critical for improving patient outcomes. This review summarizes current research advances in perioperative blood pressure management for aSAH, covering its pathophysiological mechanisms, management objectives, therapeutic approaches, and the efficacy of various strategies. Through a comprehensive analysis of existing studies, this article explores optimal blood pressure management strategies and their impact on patient prognosis, while identifying future research directions. The findings provide valuable insights for clinicians managing perioperative blood pressure in subarachnoid hemorrhage cases.
文章引用：唐思豪, 孙晓川. 动脉瘤性蛛网膜下腔出血围手术期血压管理 综述[J]. 临床医学进展, 2026, 16(6): 197-207. https://doi.org/10.12677/acm.2026.1662210

参考文献

[1] Macdonald, R.L. and Schweizer, T.A. (2017) Spontaneous Subarachnoid Haemorrhage. The Lancet, 389, 655-666. [Google Scholar] [CrossRef] [PubMed]
[2] Society of Neurosurgery of Chinese Medical Association, et al. (2024) Chinese Guideline for the Clinical Management of Patients with Ruptured Intracranial Aneurysms (2024). National Medical Journal of China, 104, 1940-1971.
[3] Al-Khindi, T., Macdonald, R.L. and Schweizer, T.A. (2010) Cognitive and Functional Outcome after Aneurysmal Subarachnoid Hemorrhage. Stroke, 41, e519-e536. [Google Scholar] [CrossRef] [PubMed]
[4] Wang, H., Song, J., Gao, F., Duan, X., Gao, X., Wang, Y., et al. (2019) Outcomes of Microsurgical Clipping vs Coil Embolization for Ruptured Aneurysmal Subarachnoid Hemorrhage: A Multicenter Real-World Analysis of 583 Patients in China. Medicine, 98, e16821. [Google Scholar] [CrossRef] [PubMed]
[5] Ascanio, L.C., Enriquez-Marulanda, A., Maragkos, G.A., Salem, M.M., Alturki, A.Y., Ravindran, K., et al. (2020) Effect of Blood Pressure Variability during the Acute Period of Subarachnoid Hemorrhage on Functional Outcomes. Neurosurgery, 87, 779-787. [Google Scholar] [CrossRef] [PubMed]
[6] Müller, T.B., Vik, A., Romundstad, P.R. and Sandvei, M.S. (2019) Risk Factors for Unruptured Intracranial Aneurysms and Subarachnoid Hemorrhage in a Prospective Population-Based Study. Stroke, 50, 2952-2955. [Google Scholar] [CrossRef] [PubMed]
[7] Sharma, D. (2020) Perioperative Management of Aneurysmal Subarachnoid Hemorrhage. Anesthesiology, 133, 1283-1305. [Google Scholar] [CrossRef] [PubMed]
[8] Darkwah Oppong, M., Steinwasser, L., Rieß, C., Wrede, K.H., Dinger, T.F., Ahmadipour, Y., et al. (2022) Blood Pressure and Outcome after Aneurysmal Subarachnoid Hemorrhage. Scientific Reports, 12, Article No. 8006. [Google Scholar] [CrossRef] [PubMed]
[9] 徐跃峤, 石广志, 魏俊吉, 等. 重症动脉瘤性蛛网膜下腔出血管理专家共识(2023) [J]. 中国脑血管病杂志, 2023, 20(2): 126-145.
[10] (2022) National Institute for Health and Care Excellence: Guidelines, in Subarachnoid Haemorrhage Caused by a Ruptured Aneurysm: Diagnosis and Management. National Institute for Health and Care Excellence (NICE) Copyright© NICE 2022.
https://www.ncbi.nlm.nih.gov/books/NBK588910/
[11] Etminan, N., Chang, H., Hackenberg, K., de Rooij, N.K., Vergouwen, M.D.I., Rinkel, G.J.E., et al. (2019) Worldwide Incidence of Aneurysmal Subarachnoid Hemorrhage According to Region, Time Period, Blood Pressure, and Smoking Prevalence in the Population: A Systematic Review and Meta-Analysis. JAMA Neurology, 76, 588-597. [Google Scholar] [CrossRef] [PubMed]
[12] Lv, B., Lan, J., Si, Y., Ren, Y., Li, M., Guo, F., et al. (2024) Epidemiological Trends of Subarachnoid Hemorrhage at Global, Regional, and National Level: A Trend Analysis Study from 1990 to 2021. Military Medical Research, 11, Article No. 46. [Google Scholar] [CrossRef] [PubMed]
[13] Song, J., Ni, W., Gu, Y., Zhu, W., Chen, L., Xu, B., et al. (2017) Epidemiological Features of Nontraumatic Spontaneous Subarachnoid Hemorrhage in China: A Nationwide Hospital-Based Multicenter Study. Chinese Medical Journal, 130, 776-781. [Google Scholar] [CrossRef] [PubMed]
[14] Molyneux, A.J., Kerr, R.S., Yu, L., Clarke, M., Sneade, M., Yarnold, J.A., et al. (2005) International Subarachnoid Aneurysm Trial (ISAT) of Neurosurgical Clipping versus Endovascular Coiling in 2143 Patients with Ruptured Intracranial Aneurysms: A Randomised Comparison of Effects on Survival, Dependency, Seizures, Rebleeding, Subgroups, and Aneurysm Occlusion. The Lancet, 366, 809-817. [Google Scholar] [CrossRef] [PubMed]
[15] Vivancos, J., Gilo, F., Frutos, R., Maestre, J., García-Pastor, A., Quintana, F., et al. (2016) Guía de actuación clínica en la hemorragia subaracnoidea. Sistemática diagnóstica y tratamiento. Neurología, 31, 649-650. [Google Scholar] [CrossRef] [PubMed]
[16] Hoh, B.L., Ko, N.U., Amin-Hanjani, S., Chou, S.H., Cruz-Flores, S., Dangayach, N.S., et al. (2023) 2023 Guideline for the Management of Patients with Aneurysmal Subarachnoid Hemorrhage: A Guideline from the American Heart Association/American Stroke Association. Stroke, 54, e314-e370. [Google Scholar] [CrossRef] [PubMed]
[17] Minhas, J.S., Moullaali, T.J., Rinkel, G.J.E. and Anderson, C.S. (2022) Blood Pressure Management after Intracerebral and Subarachnoid Hemorrhage: The Knowns and Known Unknowns. Stroke, 53, 1065-1073. [Google Scholar] [CrossRef] [PubMed]
[18] Onur, O.A., Fink, G.R., Kuramatsu, J.B. and Schwab, S. (2019) Aneurysmatic Subarachnoid Haemorrhage. Neurological Research and Practice, 1, Article No. 15. [Google Scholar] [CrossRef] [PubMed]
[19] 熊性华. 蛛网膜下腔出血患者术后再出血的影响因素[J]. 河南医学研究, 2022, 31(23): 4297-4300.
[20] Zhao, B., fan, Y., Xiong, Y., Yin, R., Zheng, K., Li, Z., et al. (2016) Aneurysm Rebleeding after Poor-Grade Aneurysmal Subarachnoid Hemorrhage: Predictors and Impact on Clinical Outcomes. Journal of the Neurological Sciences, 371, 62-66. [Google Scholar] [CrossRef] [PubMed]
[21] Gathier, C.S., Zijlstra, I.A.J., Rinkel, G.J.E., Groenhof, T.K.J., Verbaan, D., Coert, B.A., et al. (2022) Blood Pressure and the Risk of Rebleeding and Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage. Journal of Critical Care, 72, Article ID: 154124. [Google Scholar] [CrossRef] [PubMed]
[22] Gathier, C.S., van den Bergh, W.M. and Slooter, A.J.C. (2014) HIMALAIA (hypertension Induction in the Management of Aneurysmal Subarachnoid Haemorrhage with Secondary Ischaemia): A Randomized Single-Blind Controlled Trial of Induced Hypertension Vs. No Induced Hypertension in the Treatment of Delayed Cerebral Ischemia after Subarachnoid Hemorrhage. International Journal of Stroke, 9, 375-380. [Google Scholar] [CrossRef] [PubMed]
[23] Gathier, C.S., van den Bergh, W.M., van der Jagt, M., Verweij, B.H., Dankbaar, J.W., Müller, M.C., et al. (2018) Induced Hypertension for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: A Randomized Clinical Trial. Stroke, 49, 76-83. [Google Scholar] [CrossRef] [PubMed]
[24] Koenig, M.A. (2012) Management of Delayed Cerebral Ischemia after Subarachnoid Hemorrhage. Continuum, 18, 579-597. [Google Scholar] [CrossRef] [PubMed]
[25] Öhman, J., Servo, A. and Heiskanen, O. (1991) Risks Factors for Cerebral Infarction in Good-Grade Patients after Aneurysmal Subarachnoid Hemorrhage and Surgery: A Prospective Study. Journal of Neurosurgery, 74, 14-20. [Google Scholar] [CrossRef] [PubMed]
[26] Togashi, K., Joffe, A.M., Sekhar, L., Kim, L., Lam, A., Yanez, D., et al. (2015) Randomized Pilot Trial of Intensive Management of Blood Pressure or Volume Expansion in Subarachnoid Hemorrhage (Improves). Neurosurgery, 76, 125-135. [Google Scholar] [CrossRef] [PubMed]
[27] Tawk, R.G., Hasan, T.F., D’Souza, C.E., Peel, J.B. and Freeman, W.D. (2021) Diagnosis and Treatment of Unruptured Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage. Mayo Clinic Proceedings, 96, 1970-2000. [Google Scholar] [CrossRef] [PubMed]
[28] Vergouwen, M.D.I., Vermeulen, M., van Gijn, J., Rinkel, G.J.E., Wijdicks, E.F., Muizelaar, J.P., et al. (2010) Definition of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage as an Outcome Event in Clinical Trials and Observational Studies: Proposal of a Multidisciplinary Research Group. Stroke, 41, 2391-2395. [Google Scholar] [CrossRef] [PubMed]
[29] Abdulazim, A., Heilig, M., Rinkel, G. and Etminan, N. (2023) Diagnosis of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage and Triggers for Intervention. Neurocritical Care, 39, 311-319. [Google Scholar] [CrossRef] [PubMed]
[30] Tang, C., Zhang, T. and Zhou, L. (2014) Risk Factors for Rebleeding of Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis. PLOS ONE, 9, e99536. [Google Scholar] [CrossRef] [PubMed]
[31] Calviere, L., Gathier, C.S., Rafiq, M., Koopman, I., Rousseau, V., Raposo, N., et al. (2022) Rebleeding after Aneurysmal Subarachnoid Hemorrhage in Two Centers Using Different Blood Pressure Management Strategies. Frontiers in Neurology, 13, Article 836268. [Google Scholar] [CrossRef] [PubMed]
[32] Eagles, M.E., Veilleux, C., Riva-Cambrin, J. and Macdonald, R.L. (2025) Blood Pressure Targets after Aneurysmal Subarachnoid Hemorrhage: Is Lower Better? Neurosurgery, 97, 1316-1321. [Google Scholar] [CrossRef] [PubMed]
[33] Doherty, R.J., Henry, J., Brennan, D. and Javadpour, M. (2022) Predictive Factors for Pre-Intervention Rebleeding in Aneurysmal Subarachnoid Haemorrhage: A Systematic Review and Meta-Analysis. Neurosurgical Review, 46, Article No. 24. [Google Scholar] [CrossRef] [PubMed]
[34] Wang, J., Lin, F., Zeng, M., Liu, M., Zheng, M., Ren, Y., et al. (2024) Intraoperative Blood Pressure and Cardiac Complications after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Cohort Study. International Journal of Surgery, 110, 965-973. [Google Scholar] [CrossRef] [PubMed]
[35] Neil-Dwyer, G., Mee, E., Dorrance, D. and Lowe, D. (1987) Early Intervention with Nimodipine in Subarachnoid Haemorrhage. European Heart Journal, 8, 41-47. [Google Scholar] [CrossRef] [PubMed]
[36] Maagaard, M., Karlsson, W.K., Ovesen, C., Gluud, C. and Jakobsen, J.C. (2021) Interventions for Altering Blood Pressure in People with Acute Subarachnoid Haemorrhage. Cochrane Database of Systematic Reviews, 11, CD013096. [Google Scholar] [CrossRef] [PubMed]
[37] Cho, W., Kim, J.E., Park, S.Q., Ko, J.K., Kim, D., Park, J.C., et al. (2018) Korean Clinical Practice Guidelines for Aneurysmal Subarachnoid Hemorrhage. Journal of Korean Neurosurgical Society, 61, 127-166. [Google Scholar] [CrossRef] [PubMed]
[38] Silverman, A., Kodali, S., Strander, S., Gilmore, E.J., Kimmel, A., Wang, A., et al. (2019) Deviation from Personalized Blood Pressure Targets Is Associated with Worse Outcome after Subarachnoid Hemorrhage. Stroke, 50, 2729-2737. [Google Scholar] [CrossRef] [PubMed]
[39] Öhman, J., Servo, A. and Heiskanen, O. (1991) Long-term Effects of Nimodipine on Cerebral Infarcts and Outcome after Aneurysmal Subarachnoid Hemorrhage and Surgery. Journal of Neurosurgery, 74, 8-13. [Google Scholar] [CrossRef] [PubMed]
[40] Sandow, N., Diesing, D., Sarrafzadeh, A., Vajkoczy, P. and Wolf, S. (2016) Nimodipine Dose Reductions in the Treatment of Patients with Aneurysmal Subarachnoid Hemorrhage. Neurocritical Care, 25, 29-39. [Google Scholar] [CrossRef] [PubMed]
[41] Stoehr, K.A., Bartolome, D., Jayasundara, S., Thinzar, P., Vargas, D., Kim, J., et al. (2025) Impact of Nimodipine-Induced Blood Pressure Reductions on Cerebral Autoregulation and Functional Outcome after Aneurysmal Subarachnoid Hemorrhage. Neurocritical Care, 43, 842-852. [Google Scholar] [CrossRef] [PubMed]
[42] Yang, M., Pan, X., Liang, Z., Huang, X., Duan, M., Cai, H., et al. (2019) Association between Blood Pressure Variability and the Short-Term Outcome in Patients with Acute Spontaneous Subarachnoid Hemorrhage. Hypertension Research, 42, 1701-1707. [Google Scholar] [CrossRef] [PubMed]
[43] Busl, K.M., Bogossian, E.G., Claassen, J., Helbok, R., Provencio, J.J., Robba, C., et al. (2025) Beyond the Bleed: Complications after Aneurysmal Subarachnoid Hemorrhage. Pathophysiology, Clinical Implications, and Management Strategies: A Review. Critical Care, 29, Article No. 414. [Google Scholar] [CrossRef] 
[44] Mocco, J., Ransom, E.R., Komotar, R.J., Schmidt, J.M., Sciacca, R.R., Mayer, S.A., et al. (2006) Preoperative Prediction of Long-Term Outcome in Poor-Grade Aneurysmal Subarachnoid Hemorrhage. Neurosurgery, 59, 529-538. [Google Scholar] [CrossRef] [PubMed]

为你推荐