Steps to consider in the approach and management of critically ill patient with spontaneous intracerebral hemorrhage
Steps to consider in the approach and management of critically ill patient with spontaneous intracerebral hemorrhage作者机构：Neurocritical Care Unit Intensive Care Unit San Juan Bautista Hospital Intensive Care Unit Leónidas Lucero Hospital Internal Medicine Santa Maria Nuova Hospital Neurological Service San Camillo de’ Lellis General Hospital Neurological Section SMDN-Center for Cardiovascular Medicine and Cerebrovascular Disease Prevention
出 版 物：《World Journal of Critical Care Medicine》 (世界重症医学杂志)
年 卷 期：2015年第4卷第3期
页 面：213-229页
学科分类：1002[医学-临床医学] 100204[医学-神经病学] 10[医学]
主 题：Intracerebral hemorrhage Prognosis Hematoma expansion Inflammation Hemostatic therapy Oral anticoagulants
摘 要：Spontaneous intracerebral hemorrhage is a type of stroke associated with poor outcomes. Mortality is elevated, especially in the acute phase. From a pathophysiological point of view the bleeding must traverse different stages dominated by the possibility of re-bleeding, edema, intracranial hypertension, inflammation and neurotoxicity due to blood degradation products, mainly hemoglobin and thrombin. Neurological deterioration and death are common in early hours, so it is a true neurologicalneurosurgical emergency. Time is brain so that action should be taken fast and accurately. The most significant prognostic factors are level of consciousness, location, volume and ventricular extension of the bleeding. Nihilism and early withdrawal of active therapy undoubtedly influence the final result. Although there are no proven therapeutic measures, treatment should be individualized and guided preferably by pathophysiology. The multidisciplinary teamwork is essential. Results of recently completed studies have birth to promising new strategies. For correct management it s important to establish an orderly and systematic strategy based on clinical stabilization, evaluation and establishment of prognosis, avoiding secondary insults and adoption of specific individualized therapies, including hemostatic therapy and intensive control of elevated blood pressure. Uncertainty continues regarding the role of surgery.
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