[临床医学]脑出血2010指南.ppt

2010 ICH 临床指南 Guidelines for the Management of Spontaneous Intracerebral Hemorrhage（自发性脑内出血的治疗指南）2010年美国卒中协和脑出血临床指南摘译 孙芸芸 梁志刚 A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association给予来自美国心脏协会/美国卒中协会的卫生保健专业人员的指南 一、Emergency Diagnosis and Assessment of ICH and Its Causes Recommendations关于脑出血的紧急诊断和评估的建议 1. Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke [p1] from ICH[p2] (Class I; Level of Evidence: A). (Unchanged from the previous guideline) CT或MRI（核磁共振成像）的快速成像便于很好地区分缺血性中风和脑出血（出血性脑中风）。（与先前的指南并无差异） 2. CT angiography and contrast-enhanced CT[p3] may be considered to help identify patients at risk for hematoma expansion (Class IIb; Level of Evidence: B), CT血管造影术和强化CT或许可以辅助鉴别有血肿扩散危险的病人 and CT angiography, CT venography, contrast-enhanced CT, contrast-enhanced MRI, magnetic resonance angiography, and magnetic resonance venography can be useful to evaluate for underlying structural lesions, including vascular malformations and tumors when there is clinical or radiological suspicion (Class IIa;Level of Evidence: B). (New recommendation) 同时，CT血管造影术、CT静脉造影术、加强CT、加强MRI（核磁共振）、磁共振血管造影、磁共振静脉造影，可以检查到潜在的结构损伤，包括临床上或放射学上怀疑的血管畸形和肿瘤。（新推荐） 二、Medical Treatment for ICH Recommendations 关于脑出血内科治疗的建议[p4] 1. Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively (Class I;Level of Evidence: C). (New recommendation) 严重缺乏凝血因子或者说有严重血小板减少症的病人，应该适当地接受外来因子或者血小板来进行治疗。（新推荐） 2. Patients with ICH whose INR[p5] is elevated due to OACs[p6] should have their warfarin withheld, receive therapy to replace vitamin K–dependent factors and correct the INR, and receive intravenous vitamin K (Class I; Level of Evidence: C). 对于那些由口服抗凝剂OACs[p7] 导致INR（国际标准化比值）升高的脑出血病人，不应该再用华法令，而该接受上述治疗来取代维生素K依赖性因子，同时，该改善INR水平、接受静脉内维生素K治疗。 PCCs[p8] 血浆凝固剂have not shown improved outcome compared with新鲜冷冻血浆 FFP[p9] but may have fewer complica