Crandall Kenneth M, Rost Natalia S, Sheth Kevin N
Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Rev Neurol Dis. 2011;8(1-2):23-9.
Intracerebral hemorrhage (ICH) is the most devastating type of stroke with the greatest mortality rate. Unfortunately there are no clinically proven therapies, and treatment is typically supportive. Given the poor prognosis, many families are faced with the decision to limit or withdraw care from those who have had an ICH. Many clinical grading systems have been developed to help stratify patients with ICH and aid in predicting prognosis. The ICH scale was the first to be developed to predict 30-day mortality and has been validated by different cohorts around the world. Since its inception in 2001, numerous other scales have been developed to predict mortality, and more importantly, functional outcome. However, in the development of these scales, patients who had care withdrawn were included in the analysis. It has been shown that the concept of poor prognosis leads to do-not-resuscitate orders, less invasive care, and eventually death. Most of these patients have care withdrawn within the first two hospital days, despite evidence to suggest early interventions may improve outcomes. As a result, the most recent guidelines suggest waiting more than 24 hours before deciding to withdraw care. The use and interpretation of these ever-advancing scales may allow physicians to better predict outcome and assist families in making important care-related decisions.
脑出血（ICH）是最具毁灭性的中风类型，死亡率最高。不幸的是，目前尚无经临床验证的治疗方法，治疗通常只是支持性的。鉴于预后不佳，许多家庭面临着对脑出血患者限制或停止治疗的决定。已经开发了许多临床分级系统来帮助对脑出血患者进行分层，并辅助预测预后。脑出血量表是首个用于预测30天死亡率的量表，并已在世界各地的不同队列中得到验证。自2001年问世以来，又开发了许多其他量表来预测死亡率，更重要的是预测功能转归。然而，在这些量表的开发过程中，分析纳入了接受停止治疗的患者。研究表明，预后不良的观念会导致下达不要复苏的医嘱、减少侵入性治疗，并最终导致死亡。尽管有证据表明早期干预可能改善预后，但大多数此类患者在入院后的头两天内就被停止了治疗。因此，最新指南建议在决定停止治疗前等待超过24小时。这些不断发展的量表的使用和解读可能会使医生更好地预测预后，并帮助家庭做出重要的治疗相关决策。
