The Effect of Inhalation Therapy with Exogenous Nitric Oxide on Oxidative Stress and Endogenous Vascular Regulation Markers in Patients with Ruptured Cerebral Aneurysms

Introduction. Non-traumatic subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysms remains one of the most severe forms of acute cerebrovascular disease with a high risk of delayed cerebral ischemia. One of the key pathogenetic mechanisms in this pathology is severe impairment of endogenous regulation of vascular tone and the development of oxidative stress. Inhaled nitric oxide therapy is considered a potential method for modulating vascular tone and reducing the risk of vasospasm. The aim of the study. Was to evaluate the effect of inhaled nitric oxide therapy on the severity of oxidative stress and endogenous factors involved in regulation of vascular tone in patients with acute non-traumatic SAH due to ruptured cerebral aneurysms. Materials and methods. The study included 57 patients with acute SAH hospitalized at the N.V. Sklifosovsky Research Institute for Emergency Medicine between 2020 and 2025. The study group consisted of 25 patients receiving inhaled nitric oxide therapy (50–80 ppm, 3–24 hours per day, 4–7 days postoperatively); the comparison group consisted of 32 patients without this therapy. Inclusion criteria: massive basal hemorrhage, aneurysm clipping within the first 72 hours, and Hunt-Hess stage II–IV. Levels of malondialdehyde (MDA), total antioxidant activity, stable nitric oxide (NOx) metabolites, angiotensin-converting enzyme (ACE), glucose, and lactate dehydrogenase (LDH) were assessed in serum and cerebrospinal fluid. Statistical analysis was performed using the Mann-Whitney U test, with a significance level of p