Department of Neurology, University Hospital Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
Curr Neurol Neurosci Rep. 2018 Aug 20;18(10):71. doi: 10.1007/s11910-018-0872-0.
The present review will cover most recent and important studies on acute treatment of intracerebral hemorrhage (ICH).
Overly pessimistic prognostication in ICH may deny meaningful recovery achieved by specialized neurocritical care. Hematoma enlargement represents the most important target of acute ICH care, which is reduced by aggressive blood pressure management (targeting a systolic blood pressure of 140 mmHg) and appropriate hemostatic treatment especially in anticoagulation-associated ICH (INR reversal using prothrombin complex concentrates, eventually idarucizumab, andexanet, or tranexamic acid). Surgical treatment strategies involving fibrinolytics either used for direct hematoma lysis or used for intraventricular clot removal with/without additional lumbar drainage show great promise. Further novel treatment strategies are underway and need validation or evaluation strongly warranting well-designed future ICH research. Several randomized and large-sized observational studies have considerably expanded the field and the evidence on how to treat acute ICH patients. Yet, the one breakthrough intervention to improve functional outcome is still missing, though various treatment concepts possibly interacting with one another have been evaluated and such treatment bundle may improve patients' outcome.
本综述将涵盖近期关于脑出血（ICH）急性治疗的最重要研究。
ICH 过于悲观的预后可能会否认专门的神经危重病护理所取得的有意义的恢复。血肿扩大是急性 ICH 治疗的最重要靶点，通过积极的血压管理（目标收缩压为 140mmHg）和适当的止血治疗可以减少血肿扩大，特别是在抗凝相关 ICH（使用凝血酶原复合物浓缩物、依达鲁单抗、andexanet 或氨甲环酸逆转 INR）。涉及纤维蛋白溶解剂的手术治疗策略，无论是用于直接血肿溶解还是用于伴或不伴额外腰椎引流的脑室内血栓清除，都显示出巨大的前景。正在进行进一步的新型治疗策略，需要强有力的验证或评估，强烈需要精心设计的未来 ICH 研究。几项随机和大型观察性研究极大地扩展了该领域，以及如何治疗急性 ICH 患者的证据。然而，改善功能预后的突破性干预措施仍然缺失，尽管已经评估了各种可能相互作用的治疗概念，这种治疗方案可能会改善患者的预后。
