Novel therapies for intracerebral hemorrhage.
Novel therapies for intracerebral hemorrhage.
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DOI：
10.1097/00075198-200404000-00003
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发表时间：
2004-04-01
影响因子：
3.3
通讯作者：
Mayer, Stephan A
中科院分区：
文献类型：
--
作者：
Rincon, Fred;Mayer, Stephan A
审查目的：总结新的病理生理学的见解和治疗的最新进展intracerebral hemorrhage.Recent Findings：脑出血后发生的损伤的病理生理机制的新兴信息是从目前的动物模型和人类研究。慢性血管变化的影响是血肿发生的基础。在血肿扩张和水肿恶化的病理生理学中提出的新机制包括兴奋性毒素和血管活性电解质的有害积累，随后是白细胞和血小板的活化，产生炎症介质，如白细胞介素-1、白细胞介素-6、细胞间粘附分子、肿瘤坏死因子α和血管内皮生长因子。金属蛋白酶的表达以及补体、凝血酶和血液降解产物的毒性作用可能在脑出血后晚期水肿形成中起作用。尽管最近试图辨别ICH的病理生理学，但脑出血的循证治疗尚不可用。治疗主要是支持性的，结果仍然很差。通常在急性情况下进行降压、颅内压监测、适当液体平衡的血液透析治疗、发热控制和癫痫预防。目前正在研究的新方法包括脑室出血的超早期止血治疗和溶栓治疗。虽然手术治疗的价值仍不清楚，一个大的，随机研究（STITCH试验）的结果是forceing.SUMMARY：前瞻性对照研究需要开发新的药物和手术治疗ICH。
PURPOSE OF REVIEW: To summarize new pathophysiologic insights and recent advances in the treatment of intracerebral hemorrhage.RECENT FINDINGS: Emerging information of the physiopathologic mechanisms of injury that occur after intracerebral hemorrhage is available from current animal models and human studies. The effects of chronic vascular changes are fundamental to the genesis of the hematoma. Novel proposed mechanisms in the pathophysiology of hematoma expansion and worsening edema include harmful accumulation of excitotoxins and osmotically active electrolytes, followed by activation of leukocytes and platelets with production of inflammatory mediators such as interleukin-1, interleukin-6, intercellular adhesion molecule, tumor necrosis factor alpha, and vascular endothelial growth factor. Expression of metalloproteinases and the toxic effects of the complement, thrombin, and blood degradation products may play a role in late edema formation after intracerebral hemorrhage. Despite recent attempts to discern the pathophysiology of ICH, evidence-based therapies for intracerebral hemorrhage are not yet available. Treatment is primarily supportive, and outcomes remain poor. Blood pressure lowering, intracranial pressure monitoring, osmotherapy with adequate fluid balance, fever control, and seizure prophylaxis are usually done in the acute setting. Novel approaches currently under study include ultra early hemostatic therapy and thrombolytic therapy for intraventricular hemorrhage. Although the value of surgical treatment remains unclear, the results of a large, randomized study (the STITCH Trial) are forthcoming.SUMMARY: Prospective controlled studies are needed to develop novel medical and surgical therapies for ICH.