Department of Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK.
Curr Opin Crit Care. 2011 Apr;17(2):106-14. doi: 10.1097/MCC.0b013e328342f823.
Spontaneous intracerebral hemorrhage (ICH) is associated with high morbidity and mortality, providing substantial scope for improvements in outcome. This review will discuss recent developments and present consensus evidence for the management of ICH.
Intracranial management strategies focus on preventing further bleeding and minimizing the risk of hematoma expansion and cerebral ischemia. Known coagulopathies should be corrected and oral anticoagulation reversed, but there is no evidence for the routine transfusion of platelets in patients taking aspirin or clopidogrel. Recombinant factor VIIa reduces hematoma expansion after ICH, but does not improve outcome and is associated with thromboembolic complications. The role and type of surgical interventions remain controversial. Early aggressive treatment, including meticulous control of blood pressure and other systemic physiological variables, improves outcome as does management in a specialized neurointensive care unit. Thromboembolic prophylaxis is routine but prophylactic antiepileptic drugs confer no benefit. Ongoing research seeks to define optimal blood pressure, glucose and temperature targets, the role and type of surgery, and potential neuroprotective strategies.
Well organized, multimodal therapy optimizing intracranial and systemic physiological variables improves outcome after ICH. Recent guidelines provide a useful consensus evidence-based framework for the management of acute ICH.
自发性脑出血（ICH）发病率和死亡率均较高，因此有很大的改善预后的空间。本文将讨论 ICH 管理的最新进展和现有共识证据。
颅内管理策略侧重于防止进一步出血和尽量减少血肿扩大和脑缺血的风险。已知的凝血障碍应予以纠正，并逆转口服抗凝剂，但在服用阿司匹林或氯吡格雷的患者中，常规输注血小板并无证据支持。重组因子 VIIa 可减少 ICH 后的血肿扩大，但不能改善预后，并且与血栓栓塞并发症相关。手术干预的作用和类型仍存在争议。早期积极治疗，包括仔细控制血压和其他全身生理变量，以及在专门的神经重症监护病房中进行管理，均可改善预后。血栓栓塞预防是常规的，但预防性抗癫痫药物并无益处。正在进行的研究旨在确定最佳血压、血糖和体温目标、手术的作用和类型以及潜在的神经保护策略。
组织良好的多模式治疗方法可优化颅内和全身生理变量，改善 ICH 后的预后。最近的指南为急性 ICH 的管理提供了有用的共识循证框架。
