戴正泽;王辉军;赵应群;

• 1:南京市浦口医院神经内科
• 2:东南大学中大医院无锡分院神经外科
• 3:南京市浦口医院神经外科

摘要(Abstract)：

脑出血是危害最严重的脑卒中类型,早期血肿扩大是其不良预后的重要危险因素,血肿扩大的存在,影响了超早期外科治疗的疗效。目前已确认一系列与血肿扩大相关的危险因素,包括高血压及初始血肿部位、形态和体积等。CTA点征和血清标志物有助预测早期血肿扩大。目前尚不清楚早期血肿扩大的病理生理机制,但通过血肿周围破裂血管持续出血引起血肿扩大的模型研究得到一些证据支持。阻止血肿扩大为目标的临床试验性治疗虽然减少了血肿扩大,但能否改善患者预后尚无定论。至今为止,作为最易干预的不良预后相关危险因素,血肿扩大是潜在的重要治疗靶点。

关键词(KeyWords)： 脑出血;血肿扩大;因素;临床试验

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 戴正泽;王辉军;赵应群;

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参考文献(References)：

• [1]Steiner T,Al-Shahi Salman R,Beer R,et al.European Stroke Organisation(ESO)guidelines for the management of spontaneous intracerebral hemorrhage[J].Int J Stroke,2014,9(7):840-855.
• [2]Davis SM,Broderick J,Hennerici M,et al.Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage[J].Neurology,2006,66(8):1175-1181.
• [3]Dowlatshahi D,Demchuk AM,Flaherty ML,et al.Defining hematoma expansion in intracerebral hemorrhage:relationship with patient outcomes[J].Neurology,2011,76(14):1238-1244.
• [4]Mayer SA,Brun NC,Begtrup K,et al.Efficacy and safety of recombinant activated factorⅦfor acute intracerebral hemorrhage[J].N Engl J Med,2008,358(20):2127-2137.
• [5]Anderson CS,Heeley E,Huang Y,et al.Rapid bloodpressure lowering in patients with acute intracerebral hemorrhage[J].N Engl J Med,2013,368(25):2355-2365.
• [6]Qureshi AI,Palesch YY.Antihypertensive Treatment of Acute Cerebral Hemorrhage(ATACH)II:design,methods,and rationale[J].Neurocrit Care,2011,15(3):559-576.
• [7]Fisher CM.Pathological observations in hypertensive cerebral hemorrhage[J].J Neuropathol Exp Neurol,1971,30(3):536-550.
• [8]Greenberg SM,Vonsattel JP,Segal AZ,et al.Association of apolipoprotein E epsilon2and vasculopathy in cerebral amyloid angiopathy[J].Neurology,1998,50(4):961-965.
• [9]Brouwers HB,Biffi A,Ayres AM,et al.Apolipoprotein E genotype predicts hematoma expansion in lobar intracerebral hemorrhage[J].Stroke,2012,43(6):1490-1495.
• [10]Delgado Almandoz JE,Yoo AJ,Stone MJ,et al.Systematic characterization of the computed tomography angiography spot sign in primary intracerebral hemorrhage identifies patients at highest risk for hematoma expansion:the spot sign score[J].Stroke,2009,40(9):2994-3000.
• [11]Divani AA,Majidi S,Luo X,et al.The ABCs of accurate volumetric measurement of cerebral hematoma[J].Stroke,2011,42(6):1569-1574.
• [12]Brott T,Broderick J,Kothari R,et al.Early hemorrhage growth in patients with intracerebral hemorrhage[J].Stroke,1997,28(1):1-5.
• [13]Brouwers HB,Falcone GJ,McNamara KA,et al.CTA spot sign predicts hematoma expansion in patients with delayed presentation after intracerebral hemorrhage[J].Neurocrit Care,2012,17(3):421-428.
• [14]Ohwaki K,Yano E,Nagashima H,et al.Blood pressure management in acute intracerebral hemorrhage:relationship between elevated blood pressure and hematoma enlargement[J].Stroke,2004,35(6):1364-1367.
• [15]Fujii Y,Tanaka R,Takeuchi S,et al.Hematoma enlargement in spontaneous intracerebral hemorrhage[J].J Neurosurg,1994,80(1):51-57.
• [16]Broderick JP,Diringer MN,Hill MD,et al.Determinants of intracerebral hemorrhage growth:an exploratory analysis[J].Stroke,2007,38(3):1072-1075.
• [17]Brott T,Broderick J,Kothari R,et al.Early hemorrhage growth in patients with intracerebral hemorrhage[J].Stroke,1997,28(1):1-5.
• [18]Yildiz OK,Arsava EM,Akpinar E,et al.Previous antiplatelet use is associated with hematoma expansion in patients with spontaneous intracerebral hemorrhage[J].J Stroke Cerebrovasc Dis,2012,21(8):760-766.
• [19]Kuwashiro T,Yasaka M,Itabashi R,et al.Enlargement of acute intracerebral hematomas in patients on long-term warfarin treatment[J].Cerebrovasc Dis,2010,29(5):446-453.
• [20]Ruiz JL,Colorado H,Loy MC,et al.Diagnosis and treatment of intracerebral hemorrhage[J].Rev Invest Clin,2002,54(3):275-280.
• [21]Demchuk AM,Dowlatshahi D,Rodriguez-Luna D,et al.Prediction of haematoma growth and out-come in patients with intracerebral haemorrhage using the CT-angiography spot sign(PREDICT):aprospective observational study[J].Lancet Neurol,2012,11(4):307-314.
• [22]Du Q,Yang DB,Shen YF,et al.Plasma leptin level predicts hematoma growth and early neurological deterioration after acute intracerebral hemorrhage[J].Peptides,2013,45:35-39.
• [23]邱学才,常魏,张丽娟.发病后不同时间手术治疗高血压脑出血的临床研究[J].现代预防医学,2014,41(4):757-759.
• [24]Delcourt C,Huang Y,Arima H,et al.Hematoma growth and outcomes in intracerebral hemorrhage:the INTERACT1study[J].Neurology,2012,79(4):314-319.
• [25]Anderson CS,Huang Y,Wang JG et al.Intensive blood pressure reduction in acute cerebral haemorrhage trial(INTERACT):a randomised pilot trial[J].Lancet Neurol,2008,7(5):391-399.
• [26]Arima H,Huang Y,Wang JG,et al.Earlier blood pressurelowering and greater attenuation of hematoma growth in acute intracerebral hemorrhage:INTERACT pilot phase[J].Stroke,2012,43(8):2236-2238.
• [27]Antihypertensive Treatment of Acute Cerebral Hemorrhage(ATACH)investigators.Antihypertensive treatment of acute cerebral hemorrhage[J].Crit Care Med,2010,38(2):637-648.
• [28]Mayer SA,Davis SM,Skolnick BE,et al.Can a subset of intracerebral hemorrhage patients benefit from hemostatic therapy with recombinant activated factorⅦ[J].Stroke,2009,40(3):833-840.
• [29]彭斌.脑出血的治疗进展[J].中国神经免疫学和神经病学杂志,2012,19(3):164-166.
• [30]Holbrook A,Schulman S,Witt DM,et al.Evidence-based management of anticoagulant therapy:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2Suppl):e152S-184S.
• [31]Sarode R,Milling TJ Jr,Refaai MA,et al.Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding:a randomized,plasma-controlled,phaseⅢb study[J].Circulation,2013,128(11):1234-1243.
• [32]Brody DL,Aiyagari V,Shackleford AM,et al.Use of recombinant factor vIIa in patients with warfarin-associated intracranial hemorrhage[J].Neurocrit Care,2005,2(3):263-267.
• [33]Schlunk F,Van Cott EM,Hayakawa K,et al.Recombinant activated coagulation factorⅦand prothrombin complex concentrates are equally effective in reducing hematoma volume in experimental warfarin-associated intracerebral hemorrhage[J].Stroke,2012,43(1):246-249.