课件：出血性脑卒中.ppt

治疗treatment 急性期治疗原则上是制止继续出血、降低颅内压、去除病因、防治并发症（complication），降低病死率和致残率 一般治疗及对症治疗 避免继续出血或再出血诱因To prevent bleeding or bleeding incentives 对症处理Symptomatic treatment 降低颅内压Lower intracranial pressure 防治再出血prevent and cure rehaemorrhagia 安静休息，绝对卧床4-6周(Absolute bed rest, mild sedation and analgesics for headache) 调控血压regulation blood pressure 止血治疗hemostasis 外科手术operation 治疗treatment 防治脑血管痉挛(vasospasm) 维持正常血容量和血压Maintain normal blood volume and blood pressure 早期使用钙通道阻滞剂：尼莫地平 Early use of calcium channel blockers:Nimodipine 早期手术operation in earlier period 防治脑积水(hydrocephalus) 药物治疗medicine therapy 脑室穿刺脑脊液外引流术ventricular puncture and cerebrospinal fluid drainage 脑脊液置换治疗cerebrospinal fluid replacement 脑脊液分流术cerebrospinal fluid by-pass technique 预后prognosis 动脉瘤首次出血约25%死亡；再出血病死率约50% 25% die subsequently from the initial hemorrhage or ite complications,and 50% die from rebleeding. 脑血管畸形和动脉硬化引起的预后较好 the prognosis of subarachnoid hemorrhage which cause by cerebral vascular malformations and arteriosclerosis is bettter 后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用 资料仅供参考，实际情况实际分析 * * 出血性脑卒中hemorrhagic apoplexy 中南大学湘雅医院神经内科 谷文萍 Wenping Gu,MD.PhD. Neurology Department, Xiangya Hospital, central south University 脑出血cerebral hemorrhage 脑出血cerebral hemorrhage 是指原发性非外伤性脑实质内出血 发病率高，占全部脑卒中20％—30％ 80%以上由高血压性脑内细小动脉病变引起,固又称高血压动脉硬化性脑出血 Hypertension is the most common underlying cause of nontraumatic intracerebral hemorrhage 病因与发病机制etiopathogenisis and pathogenesy 高血压性脑内细小动脉硬化 高血压性脑动脉硬化时可有脑内细小动脉透明变性、纤维素样坏死，病变管壁在血流冲击下形成微动脉瘤 hypertension appears to promote structural changes including lipohyalinosis, fibrinoid necrosis and microaneurysm formation in the walls of pinetrating arteries,predisposing them to intracerebral hemorrhage. 导致脑动脉管壁薄弱(cerebral arteries vessel wall weak )的其他疾病 血液系统疾病(hematological system disease ) 肿瘤卒中(tumor apoplexy) 原因不明(unknown aetiology ) 病理pathology 多为脑动脉深穿支破裂所致 豆纹动脉最为常见，次为丘脑穿通动脉 多发于大脑半球基底核区，次为脑叶、脑桥、小脑和脑室等 Most hypertensive hemorrhages originate in certain areas of predilecti