自发性幕上性脑出血的诊疗现状与进展

Current Status and Advances in Diagnosis and Treatment of Spontaneous Supratentorial Intracerebral Hemorrhage

摘要: 自发性幕上性脑出血是最致命的卒中类型之一，存活的患者面临着不良功能结局的风险。脑淀粉样血管病和深穿支动脉病是最常见的病因，其病理生理遵循一个复杂且动态的过程，即血管破裂、初始血肿形成、血肿和周围水肿扩张引起的直接机械性损伤，以及血肿及其代谢产物介导的继发性损伤。虽然局灶性神经功能缺损和非特异性症状是脑出血的主要临床表现，仍需要完善辅助检查进行鉴别。自发性幕上性脑出血属于神经科急症，尽早明确诊断、提供生命支持与接受卒中单元护理至关重要。相关治疗主要集中于止血治疗、血压控制和外科干预。此外，康复治疗和长期管理有助于改善预后，减少复发，部分新兴疗法展现出潜力。尽管缺乏特定有效的治疗方法，但外科干预尤其是微创手术可能改善患者的预后，为临床诊疗带来了新希望。

Abstract: Spontaneous supratentorial intracerebral hemorrhage is one of the most fatal subtypes of stroke, and patients who survive face the risk of poor functional outcome. Cerebral amyloid angiopathy and deep perforator arteriopathy are the most common etiologies, and the pathophysiology of this condition follows a complex and dynamic process involving direct mechanical injury from vessel rupture, initial hematoma formation, and expansion of the hematoma and perihematomal edema, as well as secondary injury mediated by the hematoma and its metabolites. Although focal neurological deficits and nonspecific symptoms are the main clinical manifestations of intracerebral hemorrhage, auxiliary examinations are still required for differential diagnosis. Spontaneous supratentorial intracerebral hemorrhage is a neurological emergency; early definitive diagnosis, provision of life support, and admission to a stroke unit are crucial. Related treatment primarily focuses on hemostatic therapy, blood pressure control, and surgical interventions. In addition, rehabilitation therapy and long-term management help improve prognosis and reduce recurrence, and some emerging therapies show potential. Despite the lack of a specific and effective treatment modality, surgical interventions, particularly minimally invasive surgery, may improve patient outcomes, offering new hope for clinical management.