小脑出血诊疗和预后的研究进展

Advance in diagnosis,treatment and prognosis of cerebellar hemorrhage

小脑出血是指小脑实质出血,发病迅速,极易压迫脑干或侵入第四脑室,诱发不可逆损害,为临床诊疗带来了挑战。CT和MRI仍是诊断小脑出血的主要工具,但不同部位和不同时期的小脑出血临床症状和CT表现不同,应结合患者相关病史进行临床诊断。高血压仍是引起小脑出血的主要病因,手术治疗以其快速清除血肿、缓解颅内高压、解除机械压迫的优势成为高血压脑出血治疗的重要方法,主要有传统的外科开颅血肿清除术、立体定向穿刺血肿引流术、后颅窝小骨窗开颅血肿清除术、超早期显微外科手术、CT辅助定向软通道穿刺术、Ommaya囊辅助侧脑室穿刺引流术等,疗效和预后目前尚有争议。然而国内小脑出血的诊疗仍存在缺陷,术后仍有部分患者为植物人状态或死亡,建议进一步完善该疾病的健康教育和规范医院诊疗管理,以及小脑出血的早期诊断和治疗,提高预后。

Cerebellar hemorrhage refers to the hemorrhage of cerebellar parenchyma,which develops rapid and predisposes to compress brainstem or invade the fourth ventricle.It can induce irreversible damage,which brings challenges for clinical diagnosis and treatment.CT and MRI are still the main tools for the diagnosis of cerebellar hemorrhage,but the clinical symptoms and CT manifestations of cerebellar hemorrhage at different sites and at different stages can be also different.Therefore clinical diagnosis should be made in combination with the patient's relevant medical history.Hypertension is the primary cause to cerebellar hemorrhage.Surgery,with the advantage of rapid removal of hematoma and amelioration of cranial pressure and mechanical pressure,has become the important method to cure hypertensive cerebral hemorrhage,including the traditional surgical removal of hematoma,craniotomy stereotactic puncture drainage,posterior fossa hematoma small bone window craniotomy hematoma removal,super microscopic surgery,CT assisted directed soft channel puncture,and Ommaya capsule assisted lateral ventricle puncture drainage.There are inconsistent efficacy and prognostic significance of them.However,there are still defects in the diagnosis and treatment of cerebellar hemorrhage in China,and some patients were in vegetative state or died after surgeries.It is suggested to improve the health education,standardize the management of diagnosis and treatment in hospitals,especially for the early diagnosis and treatment of cerebellar hemorrhage.