读书报告 小脑出.pptVIP

recommendation 1. For most patients with ICH, the usefulness of surgery is uncertain(Class IIb; Level of Evidence: C).(New recommendation) Specific exceptions to this recommendation follow 2. Patients with cerebellar hemorrhage who are deteriorating neurologically or who have brainstem compressionand/or hydrocephalus from ventricular obstruction should undergo surgical removal of the hemorrhage as soon as possible(Class I; Level of Evidence: B).(Revised from the previous guideline) Initial treatment of these patients with ventricular drainage alone rather than surgical evacuation is not recommended(Class III; Level of Evidence: C).(New recommendation) 3. For patients presenting with lobar clots30 mL and within 1 cm of the surface, evacuation of supratentorial ICH by standard craniotomy might be considered(Class IIb; Level of Evidence: B).(Revised from the previous guideline) 4. The effectiveness of minimally invasive clot evacuation utilizing either stereotactic or endoscopic aspiration with or without thrombolytic usage is uncertain and is considered investigational (Class IIb; Level of Evidence: B).(New recommendation) 5. Although theoretically attractive, no clear evidence at present indicates that ultra-early removal of supratentorial ICH improves functional outcome or mortality rate. Very early craniotomy may be harmful due to increased risk of recurrent bleeding(Class III; Level of Evidence: B).(Revised from the previous guideline) 脑出血选择手术指证 1.对于大多数ICH患者而言，手术的作用尚不确定。（Ⅱb C） 2.小脑出血伴神经功能恶化、脑干受压和/或脑室梗阻致脑积水者应尽快手术清除血肿。（Ⅰ B） 不推荐以脑室引流作为该组患者的初始治疗。（Ⅲ C） 3.脑叶出血超过30ml且血肿距皮层表面1cm以内者，可考虑开颅清除幕上血肿。（Ⅱb B） 4.把立体定向设备或内镜单用，或与溶栓药物联用，以微创的方式清除血肿，其效果尚不确定，目前正处于研究阶段。（Ⅱb B） 5.尽管理论上来看有效，但是没有明确的证据表明超早期清除幕上血肿可以改善临床预后或降低死亡率。早期开颅清除血肿可能增加再出血的风险，从而产生负面作用。（Ⅲ B） 血压控制 收缩压150-220mmHg的住院患者，快速降压至140mmHg可能是安全的（Ⅱa B）。 高血压的ICH患者降压推荐意见（ C级推荐） 1.SBP200mmHg或MAP150mmHg,建议持续静脉应用降压药物快速降压，测血压，5min/次。 2.SBP180mmHg或MAP130mmHg，且可能存在颅内高压，可考虑监测颅内压，并间断或持续静脉应用降压药物以降压，保持脑灌注压不低于60mmHg。 3.SBP180mmHg或MAP130mmHg,且没