脑出血认识及处理.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2/4/2015,#,脑出血认识及处理,脑出血的部位,基底节出血,壳核出血,丘脑出血,尾状核出血,基底节出血,壳核出血,丘脑出血,尾状核出血,基底节,区出血,1,、壳核出血,约,占,50%60%,，,豆,纹动脉外侧在破裂,引起,肢体症状，临床上较为多,见,内囊,受损的引起的对侧偏瘫，还可有双眼向病灶一侧凝视，偏身感觉障碍等,。,昏迷,、呼吸心跳受影响，甚至出现短时间内,死亡,丘脑出血,丘脑穿支动脉或者丘脑膝状体动脉破裂,与壳核出血类似的症状,如偏身运动障碍、感觉障碍等，可出现精神障碍，临床上常见的有,情绪低落、淡漠,等，还可出现,痴呆、记忆力下降,等症状,出血量较大亦可短时间内危急生命。由于位置靠近第三脑室，丘脑出血症状容易反复，还易出现持续性顽固高热等症状。内囊内型出血偏身感觉障碍,脑叶出血,发生率较少，约占脑出血的,5%10%,，一般合并有颅内血管畸形、血液病、烟雾病等患者常见，血肿常见于一个脑叶内，有时也会累计两,个脑叶,，临床上以顶叶最为常见，因为出血位置较为表浅，血肿一般较大，根据不同的部位以及出血量，临床表现较为多见复杂，可有肢体偏瘫、癫痫发作、失语、头痛、尿失禁、视野缺损等等。,脑干出血,脑桥出血,中脑出血,延髓出血,昏迷、四肢瘫痪、,呼吸困难,急性应激性溃疡，中枢,性顽固,高热,多数,病人在发病后不久就出现多器官功能衰竭，常在发病后,48,小时内死亡,小脑出血,眩晕、,共济失调,频繁,呕吐、后枕部剧烈,疼痛,一般,不会出现肢体偏瘫症状，小脑出血量较大时刻出现脑桥受压影响呼吸功能,。,小脑蚓,部（双侧小脑半球中央部位）出血后血肿可压迫四脑室影响脑脊液循环，短时间内出现急性脑积水,脑室出血,突发头痛、呕吐、,颈强直,少量,时：头痛，恶心，呕吐，,Kerning,征,(+),，伴或不伴意识障碍,。,大量,时,：很快,进入昏迷症状。,“,铸型样“，并流入蛛网膜下腔。立即昏迷，患者四肢瘫痪，瞳孔先缩小，随后散大，高热，呼吸深大，取大脑僵直，并迅速死亡。,识别,The abrupt onset of focal neurological symptoms,is presumed,to be,vascular in origin until proven otherwise.However,it,is impossible,to know whether symptoms are due to ischemia,or hemorrhage,based on clinical characteristics alone.,Vomiting,systolic,BP 220 mm Hg,severe headache,coma,or,decreased level,of consciousness,and progression over minutes or hours,all suggest ICH,CT,is very,sensitive for identifying acute hemorrhage and is,considered the,gold,standard,2010 Guidelines,for the Management of Spontaneous Intracerebral Hemorrhage,高血压处理,Blood pressure reduction to a particular target in acute ICH hasbeen explored in one large RCT and two pilot RCTs(2325).,European Stroke Organisation(ESO)guidelines for the management of,spontaneous intracerebral hemorrhage,推荐,止血药物,Additional information:,510 mg intravenous vitamin,K,to,patients on vitamin K antagonists,or,intravenous,protamine sulfate,to patients on heparin.,The risk of a thrombotic,event occurring,due to the normalization of coagulation for,shorter periods,of time than a week is considered low for most,indications compared,with the possible benefit of stopping,hematoma expansion,or re-bleeding,.,There,is no,specific antidote available for any of the NOACs,and,clinical experience,with hemostatic agents in NOAC-associated,bleeding is,scarce.,Thats All,Thanks For All Your Attention!,