Shah Qaisar A, Ezzeddine Mustapha A, Qureshi Adnan I
Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA.
J Neurol Sci. 2007 Oct 15;261(1-2):74-9. doi: 10.1016/j.jns.2007.04.036. Epub 2007 Jun 5.
Non-traumatic or spontaneous intracerebral hemorrhage (ICH) is defined as intra-parenchymal bleeding with or without extension into the ventricles and rarely into the subarachoid space. Primary ICH in most cases is associated with chronic hypertension. Acute hypertension is associated with hematoma expansion, and poor neurological outcome. The treatment of hypertension in acute ICH is a topic of controversy. Experiments have shown an area of ischemia around the hematoma, with the reduction of regional cerebral blood flow (CBF) secondary to compression of microvasculature. Not all scientific results agree with the above findings. Recent studies have shown that CBF decreases in the perihematoma region but with concomitant reduction of cerebral metabolism, which would argue against an area of ischemia in the perihematoma region. Based on the above result, there have been several clinical trials looking at clinical outcome and decrease in hematoma expansion rates with reduction of blood pressure acutely after ICH. The parameters for the blood pressure control are still under investigation. The American Heart Association has put forward guidelines for blood pressure control which have been adopted in the centers around the country. We have described the protocol we use at our center for the blood pressure control in patients with acute ICH.
非创伤性或自发性脑出血（ICH）定义为脑实质内出血，可伴有或不伴有向脑室的扩展，极少扩展至蛛网膜下腔。大多数情况下，原发性ICH与慢性高血压有关。急性高血压与血肿扩大及不良神经功能结局相关。急性ICH患者高血压的治疗是一个有争议的话题。实验表明，血肿周围存在缺血区域，这是由于微脉管系统受压继发局部脑血流量（CBF）减少所致。并非所有科学研究结果都与上述发现一致。近期研究表明，血肿周围区域的CBF降低，但脑代谢也随之降低，这表明血肿周围区域不存在缺血区。基于上述结果，已经开展了多项临床试验，观察ICH后急性降低血压对临床结局及血肿扩大率降低的影响。血压控制参数仍在研究中。美国心脏协会已提出血压控制指南，该指南已在全国各中心采用。我们描述了我们中心用于急性ICH患者血压控制的方案。
