《高血压性脑出血中国多学科诊治指南》急救诊治解读

Interpretation of emergency treatment of Chinese multidisciplinary guideline for management of hypertensive intracerebral hemorrhage

自发性脑出血(spontaneous intracerebral hemorrhage,SICH)因发病率、病死率、致残率长期居高不下,而造成严重的家庭社会负担。其中高血压性脑出血(hypertensive intracerebral hemorrhage,HICH)是最常见的一种,占SICH的50%~70%。继2015年由中华医学会神经外科分会、中国医师协会急诊医师分会、国家卫生和计划生育委员会脑卒中筛查与防治工程委员会制定《自发性脑出血诊断治疗中国多学科专家共识》[1],以及2019年由中华医学会神经病学分会、中华医学会神经病学分会脑血管病学组发表《中国脑出血诊治指南(2019)》[2]后,结合近年来研究进展,在2020年针对我国SICH中最常见的HICH发表了最新的《高血压性脑出血中国多学科诊治指南》[3]。该版指南就HICH的急救处理、影像学检查、诊断与鉴别诊断、非手术与手术治疗、术后康复等相关问题做了详细的介绍。本文针对2020年该版指南的急救诊治部分进行解读,以期规范HICH早期救治,从而改善预后。

Spontaneous intracerebral hemorrhage( SICH) has caused serious family and social burdens because of its high rate of morbidity,mortality and disability. Hypertensive intracerebral hemorrhage( HICH) is the most common one,which accounts for 50%-70% of SICH. After Chinese multidisciplinary expert consensus for management of spontaneous intracerebral hemorrhage was published by the Neurosurgery Branch of Chinese Medical Association,Emergency Physicians Branch of Chinese Medical Association,Stroke Screening and Prevention Engineering Committee of National Health and Family Planning Commission in 2015 and Chinese guidelines for diagnosis and treatment of cerebral hemorrhage( 2019) was published by Neurology Branch of Chinese Medical Association and Cerebrovascular Disease Group of Neurology Branch of Chinese Medical Association,Chinese multidisciplinary guideline for management of hypertensive intracerebral hemorrhage was designed and published in 2020 for HICH which was the most common type of SICH in China. Emergency management,imaging characteristics,diagnosis and differential diagnosis,operative and non-operative treatment and rehabilitation are comprehensively introduced in this guideline. We interpret emergency treatment part in this study to standardize early management of HICH and improve the prognosis.