顱內動脈瘤破裂引發之蜘蛛膜下腔出血（aneurysmal subarachnoid hemorrhage；ASAH）是一種嚴重而常見的神經外科急症。目前已有許多文獻報告指出ASAH後會引發一連串的自由基和脂質過氧化反應，而導致血管痙攣的結果。 然而人體血漿中特有的抗自由基物質，可保護細胞免於受到自由基的傷害的機轉，尤其是維生素C及維生素E；可降低自由基對細胞氧化造成的脂質過氧化反應而減少血管痙攣形成。同時減少脂質過氧化反應的代謝後產物，如thiobarituric acid-reactive substance（TBARS）之產生，本研究是以2002年3月至2003年2月一年中，在彰化基督教醫院神經外科所收集的37個自發性蜘蛛膜下腔出血患者，經腦血管攝影證實為顱內動脈瘤破裂的個案，在動脈瘤破裂後第1天、第2天、第5天、第10天、第15天抽取靜脈血分析維生素C、維生素E及TBARS，所能得到的結果和以274個正常人禁食八小時後的靜脈血中維生素C、維生素E及TBARS比較，發現維生素C、維生素E從第一天開始到第十五天均有顯著的下降，而TBARS從第一天開始到第十五天均有顯著上升（P<0.05）。 另外我們進一步探討發生早期（兩天內）血管痙攣的10名ASAH患者與其他27名未有早期血管痙攣ASAH患者，有顯著較高之死亡率(p<0.05)同時發現血管痙攣ASAH患者第二天之血漿中維生素C、維生素E有顯著下降，而TBARS有顯著升高(p<0.05)。 由以上的研究結果顯示，ASAH的患者，其血中抗氧化物（維生素C、維生素E）在早期均被迅速的消耗，而脂質過氧化反應迅速的升高。因此推論抗氧化物及脂質過氧化反應對於顱內動脈瘤破裂引發蜘蛛膜下腔出血之血管痙攣的演變過程的影響扮演著重要的角色。; Aneurysmal subarachnoid hemorrhage (ASAH) is a common and serious neurosurgical emergence. The incidence of SAH from ruptured saccular aneurysms is estimated to be 10/100000 in North America. After ASAH, the major risk problems are rebleeding and vasospasm. Rebleeding rate is around 19% at 14th days after primary SAH. In recent years, early surgical or endovascular obliteration of the aneurysm are used to prevent rebleeding. However vasospasm, incidence around 40-70% by angiography, remains major complications following ASAH. The role of free radicals in the development of vasospasm is pointed out by many literatures. The free radicals can initiated a variety of reactions, including the peroxidation of unsaturated fatty acids in cell membranes. Therefore,lipid peroxidation may contribute to the pathochemistry of vasospasm. Vitamin C and E are the major Antioxidants in human plasma.Both of them can prevent lipid peroxidation by free radicals, then attenuate severeity of vasospasm. In this study, we collected 37 patients of ASAH from 2002 to 2003 in Changhua Christian hospital. All received cerebral angiography within 48 hrs and proved having saccular aneurysms. Plasma samples were collected on 1st ,2nd ,5th ,10th and 15th days of admission：The Vitamin C、E and TBARS were analysed. The results showed Vitamin C、E were significantly decreased and TBARS were significantly increased since 1st day through 15th day. In these 37 patients, 10 patients showed early vasospasm (< 48hrs) by angiography with higher incidence of mortility(P<0.05).We also measured the differences of plasma Vitamin C、E and TBARS. The plasma level of Vitamin C and Vitamin E significantly decreased and TBARS significant increased in 2nd day. In conclusion, these results indicate there is strong correlation of free radicals and lipid peroxidation in ASAH and vasospasm.
