Barnes Benjamin, Hanley Daniel F, Carhuapoma Juan R
Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Curr Opin Crit Care. 2014 Apr;20(2):148-52. doi: 10.1097/MCC.0000000000000077.
Spontaneous intracerebral haemorrhage (ICH) imposes a significant health and economic burden on society. Despite this, ICH remains the only stroke subtype without a definitive treatment. Without a clearly identified and effective treatment for spontaneous ICH, clinical practice varies greatly from aggressive surgery to supportive care alone. This review will discuss the current modalities of treatments for ICH including preliminary experience and investigative efforts to advance the care of these patients.
Open surgery (craniotomy), prothrombotic agents and other therapeutic interventions have failed to significantly improve the outcome of these stroke victims. Recently, the Surgical Trial in Intracerebral Haemorrhage (STICH) II assessed the surgical management of patients with superficial intraparenchymal haematomas with negative results. MISTIE II and other trials of minimally invasive surgery (MIS) have shown promise for improving patient outcomes and a phase III trial started in late 2013.
ICH lacks a definitive primary treatment as well as a therapy targeting surrounding perihematomal oedema and associated secondary damage. An ongoing phase III trial using MIS techniques shows promise for providing treatment for these patients.
自发性脑出血（ICH）给社会带来了巨大的健康和经济负担。尽管如此，ICH仍然是唯一没有确切治疗方法的中风亚型。由于缺乏明确有效的自发性ICH治疗方法，临床实践差异很大，从积极的手术治疗到单纯的支持治疗。本综述将讨论目前ICH的治疗方式，包括初步经验以及改善这些患者治疗效果的研究进展。
开颅手术、促凝血药物和其他治疗干预措施均未能显著改善这些中风患者的预后。最近，脑出血外科试验（STICH）II评估了浅表脑实质内血肿患者的手术治疗，结果为阴性。MISTIE II和其他微创手术（MIS）试验显示有望改善患者预后，一项III期试验于2013年末启动。
ICH缺乏确切的主要治疗方法以及针对血肿周围水肿和相关继发性损伤的治疗方法。一项正在进行的使用MIS技术的III期试验显示有望为这些患者提供治疗。
