Hematoma expansion following acute intracerebral hemorrhage.
Hematoma expansion following acute intracerebral hemorrhage.
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DOI：
10.1159/000346599
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Greenberg SM
中科院分区：
文献类型：
--
作者：
Brouwers HB;Greenberg SM
脑出血是最具破坏性的卒中形式，随机对照试验证明没有特异性治疗可以改善预后。位置和基线血肿体积是死亡率的强预测因子，但在诊断时不可改变。最初血肿的扩大是预后不良的进一步标志，至少部分是可以预防的。已经确定了几个血肿扩大的风险因素，包括基线ICH体积、症状发作后的早期表现、抗凝和CT血管造影斑点征。虽然血肿扩大的生物学机制尚不清楚，但越来越多的证据支持一种模型，即初始出血部位周围的相邻血管破裂导致继发性出血。几项旨在预防血肿扩大的大型临床试验正在进行中，包括积极降低血压，在CT血管造影结果指导下使用重组凝血因子VIIa治疗，以及对无脑室内扩展的浅表血肿进行手术干预。血肿扩大是迄今为止唯一适合治疗的结果标志，因此是一个潜在的重要治疗靶点。
Intracerebral hemorrhage, the most devastating form of stroke, has no specific therapy proven to improve outcome by randomized controlled trial. Location and baseline hematoma volume are strong predictors of mortality, but are non-modifiable by the time of diagnosis. Expansion of the initial hematoma is a further marker of poor prognosis that may be at least partly preventable. Several risk factors for hematoma expansion have been identified, including baseline ICH volume, early presentation after symptom onset, anticoagulation, and the CT angiography spot sign. Although the biological mechanisms of hematoma expansion remain unclear, accumulating evidence supports a model of ongoing secondary bleeding from ruptured adjacent vessels surrounding the initial bleeding site. Several large clinical trials testing therapies aimed at preventing hematoma expansion are in progress, including aggressive blood pressure reduction, treatment with recombinant factor VIIa guided by CT angiography findings, and surgical intervention for superficial hematomas without intraventricular extension. Hematoma expansion is so far the only marker of outcome that is amenable to treatment and thus a potentially important therapeutic target.
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影响因子：
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