脳内出血: 急性治療の現在のアプローチ

Charlotte Cordonnier¹, Andrew Demchuk², Wendy Ziai³

¹University of Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, Centre Hospitalier Universitaire Lille, Department of Neurology, Lille, France.

Lancet (London, England)

|October 16, 2018

まとめ

急性自発性脳内出血は,より良い結果のために積極的な管理が必要です. 早期の血圧管理と専門医による治療はこの生命を脅かす脳出血の生存と回復を改善します

科学分野:

神経科学
神経外科
クリティカルケア医療

背景:

急性自発性脳内出血 (ICH) は,高い死亡率と限られた治療法を持つ世界的な重大な健康問題です.
ICHは複雑な状態で,臨床的およびイメージングの発見は,原因,予後および管理戦略を決定するのに役立ちます.
患者のアウトカムには,血腫の特徴 (部位,質量効果,頭蓋内圧) と脳腫や神経炎症のような二次的な合併症が影響する.

研究の目的:

急性自発性脳内出血の患者の生存と回復に影響を与える主要な要因をレビューする.
ICHの成果を改善するための証拠に基づいた管理戦略を概説する.
ICHのケアに連携した多学科アプローチの重要性を強調する.

主な方法:

脳内出血の管理に関する現在の文献と臨床的証拠のレビュー
血腫の性質と二次脳損傷を含む予後に影響を与える要因の分析
様々な治療介入の効果と管理目標の評価

主要な成果:

生存と機能回復は,血腫の位置,質量効果,頭蓋内圧と有意に関連しています.
脳の腫れ,血周神経毒性,および炎症は,悪い結果をもたらします.
中等レベルの証拠は,専門的な脳卒中治療,神経集中治療,血圧制御,凝固矯正を含む積極的な管理を支持しています.

結論:

早期の緩和ケアを避けることを含む積極的な管理戦略は,ICH患者にとって有益な効果をもたらします.
専門医による協調的なケアや神経密集的なモニタリング及早な外科的介入が不可欠です
血圧の早期管理と凝固病の逆転は,自発的な脳内出血の予後を改善するために不可欠です.

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