2014年ESO自发性脑出血管理指南.pdf

European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage Thorsten Steiner1,2, Rustam Al-Shahi Salman3, Ronnie Beer4, Hanne Christensen5, Charlotte Cordonnier6, Laszlo Csiba7, Michael Forsting8, Sagi Harnof9, Catharina J. M. Klijn10, Derk Krieger5, A. David Mendelow11, Carlos Molina12, Joan Montaner12, Karsten Overgaard5, Jesper Petersson13, Risto O. Roine14, Erich Schmutzhard4, Karsten Schwerdtfeger15, Christian Stapf16, Turgut Tatlisumak17, Brenda M. Thomas18, Danilo Toni19, Andreas Unterberg20, and Markus Wagner21* Background Intracerebral hemorrhage (ICH) accounted for 9% to 27% of all strokes worldwide in the last decade, with high early case fatality and poor functional outcome. In view of recent randomized controlled trials (RCTs) of the management of ICH, the European Stroke Organisation (ESO) has updated its evidence-based guidelines for the management of ICH. Method A multidisciplinary writing committee of 24 research- ers from 11 European countries identified 20 questions relating to ICH management and created recommendations based on the evidence in RCTs using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results We found moderate- to high-quality evidence to support strong recommendations for managing patients with acute ICH on an acute stroke unit, avoiding hemostatic therapy for acute ICH not associated with antithrombotic drug use, avoiding graduated compression stockings, using intermittent pneumatic compression in immobile patients, and using blood pressure lowering for secondary prevention. We found moderate-quality evidence to support weak recommendations for intensive lowering of systolic blood pressure to 140 mmHg within six-hours of ICH onset, early surgery for patients with a Glasgow Coma Scale score 9–12, and avoidance of corticosteroids. Conclusion These guidelines inform the management of ICH based on evidence for the effects of treatments in RCTs. Out