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《蛛網膜下腔出血診療指南》內容預覽

ubarachnoid hemorrhage (SAH) is a common and fre-quently devastating condition, accounting for 5% of all strokes and affecting as many as 30 000 Americans each year.The American Heart Association (AHA) previously published “Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage.”Since then, considerable ad- vances have been made in endovascular techniques, diagnos-tic methods, and surgical and perioperative management paradigms. Nevertheless, outcome for patients with SAH remains poor, with population-based mortality rates as high as 45% and significant morbidity among survivors.Several multicenter, prospective, randomized trials and prospective cohort analyses have influenced treatment protocols for SAH. However, rapid evolution of newer treatment modalities, as well as other practical and ethical considerations, has meant that rigorous clinical scientific assessment of the treatment protocols has not been feasible in several important areas. To address these issues, the Stroke Council of the AHA formed a writing group to reevaluate the recommendations for management of aneurysmal SAH. A consensus committee reviewed existing data in this field and prepared the recom-mendations in 1994.In an effort to update those recommen-dations, a systematic literature review was conducted based on a search of MEDLINE to identify all relevant randomized clinical trials published between June 30, 1994, and Novem- ber 1, 2006 (search terms: subarachnoid hemorrhage, cere- bral aneurysm, trial; Table 1). Each identified article was reviewed by at least 2 members of the writing group. Selected articles had to meet one of the following criteria to be included: randomized trial or nonrandomized concurrent cohort study. Case series and nonrandomized historical co- hort studies were reviewed if no studies with a higher level of evidence were available for a particular topic covered in the initial guidelines. These were chosen on the basis of sample size and the relevance of the particular studies to subjects that were covered in the initial guidelines. The committee’s recommendations were made by applying the standard AHA evidence rating scheme (Tables 2 and 3). These recom-mendations are intended to summarize the best available evidence for treatment of patients with aneurysmal SAH and to identify areas of future research. Treatments for specific patients need to be individualized.

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