医学
尼莫地平
蛛网膜下腔出血
神经保护
神经科学
创伤性脑损伤
临床试验
重症监护医学
缺血
麻醉
内科学
心理学
精神科
钙
作者
Sangami Pugazenthi,Aaron J. Norris,David C. Lauzier,Abhijit V. Lele,Anna L. Huguenard,Rajat Dhar,Gregory J. Zipfel,Umeshkumar Athiraman
标识
DOI:10.1177/0271678x231218908
摘要
Aneurysmal subarachnoid hemorrhage (SAH) carries significant mortality and morbidity, with nearly half of SAH survivors having major cognitive dysfunction that impairs their functional status, emotional health, and quality of life. Apart from the initial hemorrhage severity, secondary brain injury due to early brain injury and delayed cerebral ischemia plays a leading role in patient outcome after SAH. While many strategies to combat secondary brain injury have been developed in preclinical studies and tested in late phase clinical trials, only one (nimodipine) has proven efficacious for improving long-term functional outcome. The causes of these failures are likely multitude, but include use of therapies targeting only one element of what has proven to be multifactorial brain injury process. Conditioning is a therapeutic strategy that leverages endogenous protective mechanisms to exert powerful and remarkably pleiotropic protective effects against injury to all major cell types of the CNS. The aim of this article is to review the current body of evidence for the use of conditioning agents in SAH, summarize the underlying neuroprotective mechanisms, and identify gaps in the current literature to guide future investigation with the long-term goal of identifying a conditioning-based therapeutic that significantly improves functional and cognitive outcomes for SAH patients.
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