应当提倡大面积脑梗死后恶性脑水肿的预防理念及其研究

Calls for the awareness and research on prevention of malignant brain oedema following massive brain infarction

大面积脑梗死是缺血性脑卒中致死致残的主要类型,恶性脑水肿是大面积脑梗死预后不良的常见原因,一旦发生,治疗效果极差。当前研究和临床指南多关注恶性脑水肿发生后监护室管理及手术治疗等下游处理措施,针对恶性脑水肿防治的适宜措施相关研究明显滞后。我们认为如果能将防治关口前移,在恶性脑水肿发生前进行早期预测并及时干预,将比发生后的治疗更合理且可行。在研究方面应探索大面积脑梗死患者脑水肿特别是恶性脑水肿发生发展的自然史规律,探索早期预防干预的时间窗;研究其发生的危险因素及早期预测因素,从而筛选适宜患者进行精准干预防止或减轻恶性脑水肿发生。临床医生应重视大面积脑梗死早期临床表现,动态观察记录病情变化,及时予以综合性个体化管理,通过预防恶性脑水肿发生达到降低脑卒中疾病负担的最终目的。

Massive brain infarction is a major type of severe ischaemic stroke,for which malignant brain oedema is a common cause for poor prognosis.Existing studies and guidelines mostly focused on the intensive care and surgical treatment for malignant brain oedema,whilst there is insufficient evidence to guide the widely applicable interventions specifically targeting malignant brain oedema.We propose that early prediction and prevention may be more feasible and beneficial in practice,than the treatment for malignant brain oedema.Future research is urgently needed to a、dynamically illustrate its natural history and explore the time window for prevention;b、investigate risk factors and early predictors,to guide the selection of high-risk patients for individualised interventions.Clinical doctors should be aware of the importance of early presentation of massive brain infarction,dynamically record changes in symptoms and sign,and provide individualised and comprehensive management,with an aim to reduce the development of malignant brain oedema,and finally reduce stroke burden.