1. 130021 2. 130062 doi: 10.11842/wst.2013.06.039 R743.34 A Intracerebral Hemorrhage ICH 1.1.1, 10%~30% [1] 20 [2] ICH 125~ 1 250 ml 6~8h1 1.1 [3] 2013-04-19 2013-09-19 [4] [5] 1995~2010 元 JDZX2012067 YJS-0106 元元 1456
2013 绎 Vol.15 No.6 12 1 176 Meta 6h OR=2.72 95%CI 1.80~4.10 P<0.01 24 h OR =4.82 95% CI 2.87~8.10 P<0.01 24 h OR=1.86 95%CI 0.95~ 3.65 P=0.07 [6] 约 20 ml 89 7d 14 d [7] 80 20 g/d P<0.05 1.1.2 ICH [8] 20% 48 h [9] 205 205 108 97 6 h 130 ~160/90 ~ 100 mmhg 130~220/90~130 mmhg 24 h CT 23 36 P<0.05 2010 ICH 150~220 mmhg ICH 140 mmhg IIa B [10] 1.1.3 Herbstein [11] 20 70 CT MRI Brott [12] 3 h CT 1 h CT 26% 33% Fujitsu K [13] 3h CT 18%~38% 3~6 h CT 8%~16% 6h 24 h 2 [14] Del Bigio [15] Mayer [16] 1457
6- 喻 Recombi -nant Activated Factor 喻 rf 喻 a rf 喻 a [17] Mayer [18] 2002~2004 399 rf 喻 a ICH 3 h CT ICH rf 喻 a 40 滋 g kg -1 108 80 滋 g kg -1 92 160 滋 g kg -1 103 96 CT 1 h 24 h ICH 90 d 16% 14% 11% 29% 3 P<0.05 55% 49% 54% 69% P<0.05 90 d 18% 29% P<0.05 2008 FAST Factor VII for Acute Hemorrhagic Stroke rf 喻 a ICH ICH [19] 2010 ICH rfviia ICH III C ; rfviia ICH rfviia rfviia ICH rfviia III A [10] 1.1.4 20 90 Ca 2+ Kollmar [20] 35 [21] 68 P<0.05 P<0.05 1.1.5 Ca 2+ [22] Ca 2+ Ca 2+ Lemons [23] 1.1.6 Kellner [24] 10 6 ICH 1.2 1903 Cushing 1458
2013 绎 Vol.15 No.6 20 70~80 CT [25] 1.2.1 5 I / 域 / 芋 郁 吁 玉 域 芋 芋 郁 吁 逸 30 ml 逸 15mL 逸 10mL 逸 3 cm [26] 1.2.2 6~7 h 24 h 24 h 璍 [27] 24 h Bakshi [28] 6~7 h 1.2.3 [29] [30] >80 ml >1.0 cm 域 芋 [31] Backlund 1978 [32] CT 195 165 P<0.05 [33] [34] 10 ml 30 ml 1459
Surgical Trial in Intracerebral Hemorrhage STICH 27 83 1033 503 ICH 30 h 25%~75% 16~49 h 530 ICH [35] 逸 3 cm ICH Glasgow Coma Scale GCS 7~12 GCS 臆 8 ICH 2010 ICH ICH IIb C [10] 1.3 Neonatal Intensive Care Unit NICU Lindsay [36] 2009 31 6 936 ICH 1 OR 0.86, 95%CI 0.76~0.98 OR 0.82, 95%CI 0.73~0.92 [37] 2007 11 572 ICH PROSIT ICH OR 0.81, 95%CI 0.72~0.91 ICH 2 222 [38] : [39~43] 5 [44] 2008 12 MEDLINE Cochrane Meta 1460
2013 绎 Vol.15 No.6 [45] 2008 12 MEDLINE Cochrane Meta [46] 1991~2006 [47] 2008 8 Cochrane 1978~2008 1989 ~2008 1979~2008 1989~2008 3 1 Elliott J, Smith M. The acute management of intracerebral hemor 原 rhage: a clinical review. Anesth Analg, 2010,110(5) 颐 1419~1427. 2 Adeoye O, Woo D, Haverbusch M, et al. Surgical management and case fatality rates of intracerebral hemorrhage in 1988 and 2005. Neurosurgery, 2008, 63(6) 颐 1113~1118. 3.., 2006, 6(3) 颐 175~176. 4,.., 2009, 6(1) 颐 39~41. 5,. Meta., 2011, 10(10) 颐 735~738. 6,.., 2011, 51(27) 颐 46~47. 7.., 2011, 25(3) 颐 188~189. 8 International Society of Hypertension (ISH) 颐 statement on the man 原 agement of blood pressure in acute stroke. JHypertens, 2003,21(4) 颐 665~672. 9,,,.., 2010,11(13) 颐 62~63. 10 Morgenstern L B, Hemphill J C, Anderson C, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guide 原 line for healthcare professionals from the American Heart Associa 原 tion/american Stroke Association. Stroke, 2010, 41(9) 颐 2108~2129. 11 Herbstein D J, Schaumburg H H. Hypertension intracerebral hematoma. An investigation of the initial hemorrhage and rebleeding using chromium Cr 51-labeled erythrocytes. ArchNeurol, 1974, 30(5) 颐 412-414. 12 Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke,1997,28(1) 颐 1~5. 13 Fujitsu K, Muramoto M, Ikeda Y,et al. Indications for surgical treatment of mutational hemorrhage: Comparative study based on serial CT and time-course analysis. JNeurosurg, 1990, 73(4) 颐 518~ 525. 14 Chen S T, Chen S D, Hsu CY, et al. Progression of hypertensive intracerebral hemorrhage. Neurology, 1989, 39(11) 颐 1509~1541. 15 Del Bigio M R, Yan H J, Buist R, et al. Experimental intracere 原 bral hemorrhage in rats. Magnetic resonance imaging and histopathological correlates. Stroke, 1996, 27(12) 颐 2312~2320. 16 Mayer S A. Intracerebral hemorrhage: natural history and rationale of ultra early hemostatic therapy.intensive Care Med,2002,28 (S2) 颐 S235~S240. 17,. 喻., 2008, 14(7) 颐 1045~1047. 18 Mayer S A, Brun N, Begtrup K,et al. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med, 2005, 352 (8) 颐 777~785. 19 Mayer S A, Brun N C, Begtrup K, et al. Efficacy and safety of re 原 combinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med, 2008, 358(20) 颐 2127~2137. 20 Kollmar R, Staykov D, Dorfler A, et al. Hypothermia reduces peri 原 hemorrhagic edema after intracerebral hemorrhage. Stroke, 2010, 41 (8) 颐 1684~1689. 21,,,.., 2010,4(13) 颐 65~66. 22 Mayer S A, Lignel li A, Fink M E, et al. Perilesional blood flow and edema formation in acute intracerebral hemorrhage: A SPECT study.stroke, 1998, 29(9) 颐 1797~1798. 23 Lemons V, Chehrazi B B, Kanter R, et al. The effect of nimodip 原 1461
ine on high energy phosphates and intracellular ph during cerebral ischemia. JNeurotrauma, 1993, 10(1) 颐 73~81. 24 Kellner C P, Connolly E S. Neuroprotective strategies for intracere 原 bral hemorrhage: trials and translation. Stroke, 2010,41(10) 颐 99~102. 25,.., 2009,7(9) 颐 32~33. 26.. 颐,2008. 27 璍,,,.CT., 2006,11(5) 颐 285~287. 28 Bakshi A, Bakshi A, Banerji A K. Neuroendoscope assisted evacua 原 tion of large intracerebral hematomas 颐 introduction of a new, mini 原 mally invasive technique. Neurosurg Focus, 2004, 16(6) 颐 e9. 29,,,.., 2004, 3(4) 颐 325~327. 30 Rohde V, Rohde I, Reinges M H, et al. Frameless stereotoutically guided catheter place placement and fibrinolytic therapy for sponta 原 neous intracerebral hemotomas: technical as pect and initial clinical results.minim Invasive Neurosurg, 2000, 43(1) 颐 9~17. 31.., 2011, 39 (1) 颐 89~92. 32,.CT., 2011, 19(5) 颐 526~528. 33 Nishihara T, Teraoka A, Morita A,et al.a transparent sheath for endoscopic surgery and its application in surgical evacuation of spontaneous intracerebral hematomas. JNeurosurg,2000,92(6) 颐 1053~ 1055. 34,.., 2007, 30(6) 颐 70~72. 35 Juvela S, Kase C S. Advances in intracerebral hemorrhage manage 原 ment. Stroke, 2006, 37(2) 颐 301~304. 36 Lindsay P, Bayley M, McDonald A, et al. Toward a more effective approach to stroke: canadian best practice recommendations for stroke care. CMAJ, 2008, 178(11) 颐 1418~1425. 37 Candelise L, Gattinoni M, Bersano A, et al. Stroke-unit care for a 原 cute stroke patients: an observational follow -up study. Lancet, 2007, 369(9558) 颐 299~305. 38. 222. 2010,2010. 39,,,.., 2012, 21(12) 颐 1960~1961. 40,,.., 2012, 21(11) 颐 1783~1788. 41.., 2012, 36(6) 颐 467~468. 42,,.., 2012, 36(5) 颐 371~373. 43,,.., 2012, 9(28) 颐 113~115. 44,.., 2010, 29(8) 颐 511~513. 45,.., 2010, 29(6) 颐 367~368. 46,,,. Meta., 2008, 11(3) 颐 317~319. 47,. Meta., 2010, 12(10) 颐 74~75. Review and Commentary on Treatment of Intracerebral Hemorrhage Ren Jixiang 1,LiuHaiyan 2, Zhao Jianjun 1,ZhaoDexi 1,LiMingquan 1,WangJian 1 (1. The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun 130021, China; 2. The Second Hospital of Changchun, Changchun 130062, China) Abstract: This article was aimed to review and make a commentary on modern medicine and traditional Chinese medicine (TCM) treatment for intracerebral hemorrhage. This article introduced applications and evaluations on medi 鄄 cations to reduce intracranial pressure, blood pressure control medications, ultra-early hemostatic medications, hy 鄄 pothermia and neuroprotective agents from modern medicine treatment on acute intracerebral hemorrhage. The article also introduced the current large -scale TCM clinical trials for acute intracerebral hemorrhage treatment and some systematic reviews on medications in order to provide theoretical evidences for the clinical treatment of acute intrac 鄄 erebral hemorrhage. Keywords: Intracerebral hemorrhage, acute phase, treatment 1462