The Story of Intracerebral Hemorrhage: From Recalcitrant to Treatable Disease.
The Story of Intracerebral Hemorrhage: From Recalcitrant to Treatable Disease.
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DOI：
10.1161/strokeaha.121.033484
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发表时间：
2021-05
期刊：
影响因子：
8.3
通讯作者：
Mayer S
中科院分区：
文献类型：
--
作者：
Broderick JP;Grotta JC;Naidech AM;Steiner T;Sprigg N;Toyoda K;Dowlatshahi D;Demchuk AM;Selim M;Mocco J;Mayer S
这份特邀特别报告基于2020年11月世界卒中组织/欧洲卒中组织会议上的颁奖典礼，概述了过去35年来脑出血（ICH）急性治疗的进展。脑出血是第二种最常见和最致命的中风类型，没有科学证明的药物或手术治疗。自20世纪90年代以来的前瞻性研究表明，大多数自发性ICH的增长发生在最初的2-3小时内，ICH的增长以及由此产生的ICH和IVH的体积是可以改善结局的可改变因素。关注血压升高（BP）早期治疗的试验表明，目标收缩压为140 mm Hg，但没有一项试验的主要终点为阳性。减少自发性ICH出血的止血药物包括去氨加压素、氨甲环酸和重组凝血因子VIIa，但无明显获益，而血小板输注则与损害相关。在最初几个小时内给予止血剂对ICH的发展和潜在结局的影响最大。没有大型III期手术ICH试验的主要终点是积极的，但汇总分析表明，早期ICH清除更可能是有益的。最近的试验强调最大限度地清除凝块和最大限度地减少脑损伤的手术方法。如果我们要改善结果，ICH治疗的未来必须关注尽快提供药物和手术治疗。
This invited special report is based on an award presentation at the World Stroke Organization/European Stroke Organization Conference in November of 2020 outlining progress in the acute management of intracerebral hemorrhage (ICH) over the past 35 years. Intracerebral hemorrhage is the second most common and the deadliest type of stroke for which there is no scientifically proven medical or surgical treatment. Prospective studies from the 1990s onward have demonstrated that most growth of spontaneous ICH occurs within the first 2–3 hours and that growth of ICH and resulting volumes of ICH and IVH are modifiable factors that can improve outcome. Trials focusing on early treatment of elevated blood pressure (BP) have suggested a target systolic BP of 140 mm Hg but none of the trials were positive by their primary endpoint. Hemostatic agents to decrease bleeding in spontaneous ICH have included desmopressin, tranexamic acid, and recombinant Factor VIIa without clear benefit, and platelet infusions which were associated with harm. Hemostatic agents delivered within the first several hours have the greatest impact on growth of ICH and potentially on outcome. No large Phase III surgical ICH trial has been positive by primary endpoint but pooled analyses suggest that earlier ICH removal is more likely to be beneficial. Recent trials emphasize maximization of clot removal and minimizing brain injury from the surgical approach. The future of ICH therapy must focus on delivery of medical and surgical therapies as soon as possible if we are to improve outcomes.