治疗幕上脑出血：无望？或者重新考虑我们的战略,Stroke and Vascular Neurology

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治疗幕上脑出血：无望？或者重新考虑我们的战略
Stroke and Vascular Neurology ( IF 4.4 ) Pub Date : 2021-06-01 , DOI: 10.1136/svn-2021-001043
David Z Wang ₁ , Liping Liu _{2,

3} , Guohua Xi ₄ , Yongjun Wang _{2,

3}

Affiliation

脑出血 (ICH) 是所有中风中最致命的 (40%)。1 全世界每年约有 200 万例 ICH，但仍缺乏有效的治疗方法。ICH 体积<30 cm3 的 30 天死亡率可能为 19%。2 治疗 ICH 的临床研究一直集中在控制血压、止血治疗、手术清除凝块和有效引流脑室内血液。这些疗法背后的原则包括停止出血、防止血肿扩大、减少凝块负担、降低颅内压和预防阻塞性脑积水。然而，这些试验的结果并不理想。只有严格的血压控制和后颅窝血肿清除已纳入标准临床实践。最近，Stroke and Vascular Neurology 在网上发表了两篇关于 ICH 使用止血疗法方面的文章。基于影像学评估的氨甲环酸治疗急性脑出血生长 (TRAIGE) 试验研究了氨甲环酸对降低非增强 CT 或 CT 血管造影出现黑洞、混合或斑点征的 ICH 患者血肿扩大风险的作用。 3 ICH 患者的这三项放射学检查结果表明血肿扩大的风险较高。在发病后 8 小时内将 171 名患者随机分配至氨甲环酸或安慰剂组后，目的是…… 基于影像学评估的氨甲环酸治疗急性脑出血生长 (TRAIGE) 试验研究了氨甲环酸对降低非增强 CT 或 CT 血管造影出现黑洞、混合或斑点征的 ICH 患者血肿扩大风险的作用。 3 ICH 患者的这三项放射学检查结果表明血肿扩大的风险较高。在发病后 8 小时内将 171 名患者随机分配至氨甲环酸或安慰剂组后，目的是…… 基于影像学评估的氨甲环酸治疗急性脑出血生长 (TRAIGE) 试验研究了氨甲环酸对降低非增强 CT 或 CT 血管造影出现黑洞、混合或斑点征的 ICH 患者血肿扩大风险的作用。 3 ICH 患者的这三项放射学检查结果表明血肿扩大的风险较高。在发病后 8 小时内将 171 名患者随机分配至氨甲环酸或安慰剂组后，目的是……

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Treating supratentorial intracerebral haemorrhage: hopeless? Or rethink our strategy

Intracerebral haemorrhage (ICH) is the deadliest (40%) among all strokes.1 There are about 2 million ICHs annually worldwide, but effective treatment is still lacking. An ICH volume of <30 cm3 may have a 30-day mortality of 19%.2 Clinical research on treating ICH has been focusing on blood pressure control, haemostatic therapy, surgical evacuation of the clot and effective drainage of intraventricular blood. The principles behind these therapies include stopping the haemorrhage, preventing haematoma expansion, reducing the clot burden, reducing intracranial pressure and preventing obstructive hydrocephalus. However, the outcome of these trials has not been ideal. Only tight blood pressure control and posterior fossa haematoma evacuation have been incorporated into the standard clinical practice. Recently, Stroke and Vascular Neurology published two articles online on the aspect of using haemostatic therapy for ICH. The Tranexamic acid for acute intracerebral hemorrhage growth based on imaging assessment (TRAIGE) trial studied the effect of tranexamic acid on reducing the risk of haematoma expansion in patients with ICH with either the black hole, blend or spot sign on noncontrast CT or CT angiography.3 These three radiological findings in patients with ICH are indicative of higher risk of haematoma expansion. After randomising 171 patients to tranexamic acid or placebo within 8 hours of onset, the intent …

更新日期：2021-06-29

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