Naidech Andrew M
Continuum (Minneap Minn). 2015 Oct;21(5 Neurocritical Care):1288-98. doi: 10.1212/CON.0000000000000222.
This article updates neurologists on recent insights and management strategies of intracerebral hemorrhage (ICH).
Blood pressure reduction likely improves outcomes in patients with intracerebral hemorrhage, although not by the expected mechanism of reducing hematoma growth. One formulation of prothrombin complex concentrate for reversing severe bleeding associated with warfarin is now approved by the US Food and Drug Administration (FDA), and specific reversal therapies for the novel oral anticoagulants are in development. Neurologic monitoring frequently detects ICH worsening that requires an intervention. Platelet transfusion and pharmacologic platelet activation are promising and often used as part of patient management but have not yet been shown to improve patient outcomes.
Measurable progress continues toward establishing effective therapies to improve outcomes in patients with ICH. Blood pressure reduction and reversal of medications that exacerbate bleeding are likely to improve outcomes. Recommendations for neuromonitoring will help clinicians at the bedside attend to the most important abnormalities and optimize later quality of life. This article reviews standards for diagnosis and severity of ICH, monitoring and treatment of complications in the hospital, available interventions, and the measurement of outcomes.
本文向神经科医生介绍脑出血（ICH）的最新见解和管理策略。
降低血压可能改善脑出血患者的预后，尽管并非通过减少血肿扩大这一预期机制实现。一种用于逆转与华法林相关的严重出血的凝血酶原复合物浓缩物制剂现已获美国食品药品监督管理局（FDA）批准，针对新型口服抗凝剂的特定逆转疗法也在研发中。神经监测经常能检测到需要干预的脑出血病情恶化。血小板输注和药物性血小板激活前景良好，常作为患者管理的一部分使用，但尚未证明能改善患者预后。
在确立有效疗法以改善脑出血患者预后方面持续取得可衡量的进展。降低血压和逆转加剧出血的药物可能改善预后。神经监测建议将帮助床边的临床医生关注最重要的异常情况并优化后期生活质量。本文综述了脑出血的诊断和严重程度标准、医院并发症的监测和治疗、可用干预措施以及预后评估。
