脑出血后脑水肿药物治疗的研究进展

Research progress of drug therapy of cerebral edema after intracerebral hemorrhage

自发性脑出血是指非外伤情况下各种原因导致脑血管破裂而引起的脑实质出血,具有高发病率、高致死率、高致残率的特点。针对出血所致原发性脑损伤的治疗效果并不理想,越来越多的研究将重点放在了继发性脑损伤的治疗。脑水肿是脑出血后必然出现的病理生理过程,是最重要的继发性脑损伤之一,与患者预后直接相关。近年来对脑出血后脑水肿的临床前试验提供了许多新的药物治疗潜在靶点,但由于研究设计、样本量等多方面的不足,这些药物尚未有效转化到临床试验中,需要更多大规模、设计严谨的前瞻性临床试验的探索与验证。目前尚无明确改善脑出血预后的脑水肿治疗药物。本文总结了脑出血后脑水肿的病理生理学机制及目前具有转化潜力的治疗脑出血后脑水肿的药物供研究者参考。

Spontaneous intracerebral hemorrhage refers to parenchymal hemorrhage caused by cerebral vascular rupture under various non-traumatic circumstances and has the characteristics of high morbidity,mortality and disability rate.Therapeutic effect on primary brain injury caused by hemorrhage is not ideal,and more and more studies focus on the treatment of secondary brain injury.Cerebral edema is an inevitable pathophysiological process after intracerebral hemorrhage and is the most important factor of secondary brain injury,which is directly related to the prognosis of patients.In recent years,preclinical studies on cerebral edema after intracerebral hemorrhage have provided us with many novel therapeutic targets with potential,but these drugs have not been effectively transformed into clinical trials,and more large-scale and well-designed prospective clinical studies are needed.At present,there is no clear evidence of anti-edema drugs to improve the prognosis of intracerebral hemorrhage.This review summarizes the mechanism of cerebral edema after intracerebral hemorrhage and the current drugs with translational potential for reference.