IC: You mentioned microdialysis use in your talk. Could you comment on the feasibility of using microdialysis to monitor stroke patients outside of highly developed hospitals?
《国际循环》：你在演讲中提到使用了微透析技术。请谈下在级别较高的医院之外采用微透析技术监测卒中患者的可能性？
Dr. Wartenberg: Microdialysis is an increasingly popular research and clinical tool in the United States and Europe， but it is limited to centers with a lot of expertise， with many neurocritical care (NCC) beds， and with a lot of staff available. It is labor intensive. At the same time， placing a microdialysis catheter into the brain is not a simple neurosurgical procedure， as location is key to appropriate numbers and treatment. For hospitals in general and in countries like China， it might be feasible in the university or in an academic setting if there is enough interest available. It is also a team approach， as it would include nurses， residents， neurointensivists， and neurosurgeons，  not just for catheter placement but also for interpreting the numbers on a continuous basis. It would be helpful， but in the real world， you need to have enough staff and an academic background.
Wartenberg教授：在美国和欧洲，微透析是一个越来越受关注的研究领域和临床工具，但是微透析仅限于专业化程度较高的、神经重症监护病床数较多的和医务人员多的少数治疗中心。微透析耗费大量的人力。此外，将微透析导管置入脑部并不是一个简单的神经外科操作，因为置入部位对得出正确的结果和实施正确的治疗至关重要。对于一般的医院和中国的医院，在教学医院开展微透析可能是可行的，如果有足够兴趣的话。微透析是一项团队性的工作，因为涉及到护士、住院医生、神经介入医生和神经外科医生，不仅仅是置入导管，还涉及到监测结果的持续解读。微透析是有用处的，但是在真实世界情况下，微透析的实施需要有足够的人员和学术背景。
　IC: When it comes to treatment of malignant MCA infarction， when would you recommend performing surgery instead of more conservative treatments?
《国际循环》：谈到恶性大脑中动脉梗死的治疗，什么情况下你推荐外科手术而不是保守治疗？
　Dr. Wartenberg: This is an interesting question. The guidelines say to have decompressive hemicraniectomy available within 48 hours of stroke onset to every patient less than 60 years old who has a MCA infarction that covers more than two-thirds of the MCA territory on the CT scan. We do follow the guidelines， but we have often just waited. We saw that patients with these so-called malignant MCA infarctions did not develop brain edema， did not herniate， and did well. If you have a patient that is awake， not intubated， not sedated， that you can follow， then it might be ok to wait. But in general， if you do not have so many experts available to follow the patient closely， it is probably better to follow the guidelines and make a hemicraniectomy available to everyone who meets these criteria.
These guidelines are part of the American Heart Association guidelines， however， in the upcoming Neurocritical Care Conference in Mannheim， Germany January of 2013， there will be a consensus statement between the German and the American NCC societies on this topic. These guidelines will be available online for everybody.
Wartenberg教授：这是一个很有意思的问题。指南指出，对于在发病48小时之内就诊的、年龄<60 岁的、CT扫描显示三分之二以上大脑中动脉供血区梗死的患者，需实施去瓣减压术。我们是按照指南来实践的，但是很多情况下还是要等等看。有些恶性大脑中动脉梗死患者并没有发生脑水肿、无脑疝，同时情况良好。如果患者意识清楚，未给予鼻饲、未应用镇静药物、可以进行观察的话，那么等等看可能是可行的。但是，通常上来讲，如果没有足够的医生对患者进行严密监视的话，可能遵循指南更为合适，就是对所有符合上述标准的患者实施去瓣减压术。我提到的指南是美国心脏学会系列指南中的一部分。不过，在即将于2012年在德国曼海姆召开的神经重症监护大会上，将会公布德国和美国神经重症监护学会（NCC）的恶性大脑中动脉治疗联合共识。该共识将在网上发布。

采访稿整理

蛛网膜下腔出血的早期治疗进展

——德国哈雷-威登堡马丁路德大学Dr. Katja C. Wartenberg专访

蛛网膜下腔出血（SAH）的治疗是一个非常活跃的、新兴的科研领域，迟发性脑缺血的研究尤其如此。当前我们的注意力已从把血管痉挛作为药物和干预治疗靶点转向通过其他神经保护策略预防迟发性脑缺血的发生和预防早期脑损伤。未来研究的焦点是SAH发生后如何锁定早期脑损伤，尽快应用神经保护药物。SAH治疗领域其他进展还包括采取措施使体温恢复正常，缺血患者输血和高血糖治疗也正在研究中。

SAH has been a very active and emerging field， particularly in the area of delayed cerebral ischemia. The thought has shifted from having vasospasm as a target of medical and interventional therapies to preventing late cerebral ischemia by other neuroprotective strategies and to preventing early brain injury. The question is how to target early brain injury after SAH， as you have to be very quick in the use of neuroprotective agents. This will be the target in the future. Other developments include management of medical complications， such as inducing normothermia. More studies will also be conducted on blood transfusion for anemia and hyperglycemia.