Critical care management of acute intracerebral hemorrhage.
Critical care management of acute intracerebral hemorrhage.
复制标题
急性脑出血的重症监护管理。
DOI：
10.1007/s11940-010-0109-2
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发表时间：
2011
影响因子：
2
通讯作者：
Gilson,AaronJ
中科院分区：
文献类型：
--
作者：
Goldstein,JoshuaN;Gilson,AaronJ
意见声明脑出血是一种医疗紧急情况。它是最致命和致残的中风形式，没有个别治疗已被证明可以改善结果。然而，似乎积极的医疗护理，特别是神经科学专家的管理，提供了实质性的好处。因此，根据现有证据提供最佳支持性治疗可能会改善结局。气道管理和血压管理旨在最大限度地增加脑灌注，同时最大限度地减少持续出血，以及快速逆转抗凝治疗，可能在早期阶段很重要。此外，应努力提供仔细的血糖管理和温度管理，并最大限度地提高脑灌注压。选择的患者可能受益于脑室外引流甚至血肿清除。除极少数情况外，大多数患者在急性期应在神经科学重症监护室接受治疗。有些患者似乎没有合理的康复可能性，可以考虑限制护理，如不复苏订单或舒适措施只订单。然而，在急性期很难准确预测长期结果;应使用正式的预后工具为患者及其家属提供信息。出血稳定后，尽量减少并发症的努力包括血栓栓塞预防，物理治疗和急性康复。
Opinion statementIntracerebral hemorrhage is a medical emergency. It is the most deadly and disabling form of stroke, and no individual therapy has been demonstrated to improve outcome. However, it appears that aggressive medical care in general, and management by neuroscience specialists in particular, offers substantial benefit. Therefore, providing the best supportive care based on currently available evidence may well improve outcomes. Airway management and management of blood pressure aimed at maximizing cerebral perfusion while minimizing ongoing bleeding, as well as rapid reversal of anticoagulation, are likely to be important in the early phase. Additionally, efforts should be undertaken to provide careful glucose management and temperature management and to maximize cerebral perfusion pressure. Selected patients are likely to benefit from external ventricular drainage or even hematoma evacuation. Except in rare circumstances, most patients should be managed in a neuroscience intensive care unit during the acute phase. Some patients appear to have no reasonable likelihood of recovery and can be considered for limitations of care such as Do Not Resuscitate orders or Comfort Measures Only orders. However, it can be difficult to accurately predict long-term outcome in the acute phase; formal prognostic tools should be used to offer information to patients and their families. After the hemorrhage has stabilized, efforts to minimize complications include thromboembolism prophylaxis, physical therapy, and acute rehabilitation.