脑出血管理指南GuidelinesfortheManagementofCH.pptVIP

Guidelines for the Management of SpontaneousIntracerebral Hemorrhage(ICH) Purpose The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous ICH Methods A formal literature search of PubMed was performed from 2009 through 2013 Results Evidence-based guidelines are presented for the care of patients with acute ICH Conclusions ICH remains a serious condition for which early aggressive care is warranted.These guidelines provide a framework for goal-directed treatment of the patient with ICH Recommendations follow the American Heart Association(AHA)/American Stroke Association(ASA)smethods of classifying the level of certainty of the treatment effect and the class of evidence Emergency Diagnosis and Assessment Recommendations 1. A baseline severity score should be performed as part of the initial evaluation of patients with ICH (Class I;Level of Evidence B). (New recommendation) 2. Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from ICH(Class I; Level of Evidence A). (Unchanged from the previous guideline) 3. CTA and contrast-enhanced CT may be considered to help identify patients at risk for hematoma expansion (Class IIb; Level of Evidence B), CTA,CT venography, contrast-enhanced CT, contrastenhanced MRI, magnetic resonance angiography and magnetic resonance venography, and catheter angiography can be useful to evaluate for underlying structural lesions including vascular malformations and tumors when there is clinical or radiological suspicion(Class IIa; Level of Evidence B). (Unchanged from the previous guideline) Medical Treatment for ICH Hemostasis and Coagulopathy, Antiplatelet Agents,and (deep vein thrombosis, DVT) Prophylaxis Recommendations 1. Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively(Class I; Level of Evidence C). (Unchanged from the