Fayad P B, Awad I A
Department of Neurology, Yale University School of Medicine, New Haven, CT 06520-8018, USA.
Neurology. 1998 Sep;51(3 Suppl 3):S69-73. doi: 10.1212/wnl.51.3_suppl_3.s69.
Intracerebral hemorrhage (ICH) represents 8 to 15% of all strokes in the United States and 20 to 30% of all strokes in Japan and China. Although ICH represents a relatively small fraction of total strokes, it is a formidable disease, with a 30-day mortality rate two- to sixfold higher than that for ischemic stroke. Furthermore, it is a major cause of disability, with only 20% of patients becoming independent at 6 months. The most common risk factors for ICH are age, hypertension, and amyloid angiopathy, which are associated with damage to and weakening of the arterial/arteriolar wall leading to vessel rupture. The pathology is a dynamic one that continues to evolve over the first few days after onset. In 20 to 30% of ICH, clot volume increases over the first 24 hours and is generally associated with neurologic worsening. The final outcome from ICH is related not only to clot volume, compression, and destruction but also to potential neurotoxicity from the blood degradation products and associated neuronal ischemia. The treatment of ICH has been one of the most controversial and least well-studied areas from a medical or surgical perspective. Surgical treatment has evolved over the years and can be grouped into open and stereotactically guided surgery for hematoma evacuation. Seven thousand operations per year are performed in the United States for hematoma evacuation, although this approach has not been adequately investigated. Adjuvant medical therapies with neuroprotective agents require further investigation and may potentially have additive benefits.
在美国，脑出血（ICH）占所有中风病例的8%至15%，在日本和中国则占所有中风病例的20%至30%。尽管脑出血在中风总数中所占比例相对较小，但却是一种严重的疾病，其30天死亡率比缺血性中风高出两至六倍。此外，它还是导致残疾的主要原因，只有20%的患者在6个月后能够独立生活。脑出血最常见的风险因素是年龄、高血压和淀粉样血管病，这些因素与动脉/小动脉壁的损伤和弱化有关，进而导致血管破裂。其病理过程是动态的，在发病后的头几天内会持续演变。在20%至30%的脑出血病例中，血凝块体积在最初24小时内会增大，通常与神经功能恶化有关。脑出血的最终结局不仅与血凝块体积、压迫和破坏有关，还与血液降解产物的潜在神经毒性以及相关的神经元缺血有关。从医学或外科角度来看，脑出血的治疗一直是最具争议且研究最少的领域之一。多年来，外科治疗不断发展，可以分为用于血肿清除的开放手术和立体定向引导手术。在美国，每年有七千例进行血肿清除的手术，尽管这种方法尚未得到充分研究。使用神经保护剂的辅助药物治疗需要进一步研究，可能会带来额外的益处。
