切换至 "中华医学电子期刊资源库"

中华脑血管病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 222 -227. doi: 10.11817/j.issn.1673-9248.2021.04.005

专家论坛

小脑出血诊疗和预后的研究进展
韩旭1, 王丽琨2, 任思颖2, 伍国锋2,()   
  1. 1. 550003 贵阳,贵州医科大学临床医学院
    2. 550003 贵阳,贵州医科大学附属医院急诊科
  • 收稿日期:2020-12-14 出版日期:2021-08-09
  • 通信作者: 伍国锋
  • 基金资助:
    国家自然科学基金(81971126); 贵州省高层次留学人才创新创业择优资助项目启动(2020)05号); 贵州省卫生健康委科学技术基金项目(gzwjk2020-1-016)

Advance in diagnosis,treatment and prognosis of cerebellar hemorrhage

Xu Han1, Likun Wang2, Siying Ren2, Guofeng Wu2,()   

  1. 1. Clinical College of Guizhou Medical University, Guiyang 550003, China
    2. Department of Emergency, the Affiliated Hospital of Guizhou Medical University, Guiyang 550003, China
  • Received:2020-12-14 Published:2021-08-09
  • Corresponding author: Guofeng Wu
引用本文:

韩旭, 王丽琨, 任思颖, 伍国锋. 小脑出血诊疗和预后的研究进展[J/OL]. 中华脑血管病杂志(电子版), 2021, 15(04): 222-227.

Xu Han, Likun Wang, Siying Ren, Guofeng Wu. Advance in diagnosis,treatment and prognosis of cerebellar hemorrhage[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2021, 15(04): 222-227.

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.

1
Hackenberg KAM, Unterberg AW, Jung CS, et al. Does suboccipital decompression and evacuation of intraparenchymal hematoma improve neurological outcome in patients with spontaneous cerebellar hemorrhage? [J]. Clin Neurol Neurosurg, 2017, 155: 22-29.
2
Arnone GD, Esfahani DR, Wonais M, et al. Surgery for cerebellar hemorrhage: a national surgical quality improvement program database analysis of patient outcomes and factors associated with 30-day mortality and prolonged ventilation [J]. World Neurosurg, 2017, 106: 543-550.
3
Agrawal A, Cardinale M, Frenia D, et al. Cerebellar haemorrhage leading to sudden cardiac arrest [J]. J Crit Care Med (Targu Mures), 2020, 6(1): 71-73.
4
中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2019) [J]. 中华神经科杂志, 2019, 52(12): 994-1005.
5
Neufeld EA, Menacho ST, Shah LM. Craniocervical junction and posterior fossa dimensions can affect need for decompressive craniectomy in posterior cranial fossa hemorrhage [J]. World Neurosurg, 2019, 127: e570-e577.
6
中华医学会神经外科学分会, 中国医师协会急诊医师分会, 中华医学会神经病学分会脑血管病学组, 等. 高血压性脑出血中国多学科诊治指南 [J]. 中国急救医学, 2020, 40(8): 689-702.
7
蔡可胜, 卞文彬, 袁运尚. 高血压小脑出血破入脑室铸型的手术治疗: 38例报告 [J]. 中华神经外科疾病研究杂志, 2016, 15(3): 267-268.
8
van Essen TA, Menon DK, Lingsma HF. Unmeasured confounding in observational studies of management of cerebellar intracranial hemorrhage [J]. JAMA, 2020, 323(7): 665-666.
9
Omer A, Engelman E, Bath K, et al. Remote cerebellar hemorrhage: a case report [J]. Radiol Case Rep, 2019, 14(3): 385-389.
10
Doddamani RS, Sawarkar D, Meena RK, et al. Remote cerebellar hemorrhage following surgery for supratentorial lesions [J]. World Neurosurg, 2019, 126: e351-e359.
11
Kuroda R, Nakatani J, Akai F, et al. Remote subarachnoid haemorrhage in the posterior fossa following supratentorial surgery. Clinical observation of 6 cases [J]. Acta Neurochir (Wien), 1994, 129(3-4): 158-165.
12
Cusack TJ, Carhuapoma JR, Ziai WC. Update on the treatment of spontaneous intraparenchymal hemorrhage: medical and interventional management [J]. Curr Treat Options Neurol, 2018, 20(1): 1.
13
Al Safatli D, Guenther A, McLean AL, et al. Prediction of 30-day mortality in spontaneous cerebellar hemorrhage [J]. Surg Neurol Int, 2017, 8: 282.
14
Fakan B, Reisz Z, Zadori D, et al. Predictors of localization, outcome, and etiology of spontaneous intracerebral hemorrhages: focus on cerebral amyloid angiopathy [J]. J Neural Transm (Vienna), 2020, 127(6): 963-972.
15
中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑血管病影像应用指南2019 [J]. 中华神经科杂志, 2020, 53(4): 250-268.
16
袁哲星, 刘文, 蔡宗尧, 等. 小脑出血的CT、MRI诊断与临床 [J]. 中国医学影像技术, 2001, 17(5): 415-416.
17
Cheng AL, Batool S, McCreary CR, et al. Susceptibility-weighted imaging is more reliable than T2*-weighted gradient-recalled echo MRI for detecting microbleeds [J]. Stroke, 2013, 44(10): 2782-2786.
18
Tsai HH, Pasi M, Tsai LK, et al. Superficial cerebellar microbleeds and cerebral amyloid angiopathy: a magnetic resonance imaging/positron emission tomography study [J]. Stroke, 2020, 51(1): 202-208.
19
Reddy ST, Savitz SI. Hypertension-related cerebral microbleeds [J]. Case Rep Neurol, 2020, 12(3): 266-269.
20
Renard D, Tatu L, Thouvenot E. Infratentorial cerebral microbleeds in patients with cerebral amyloid angiopathy [J]. J Stroke Cerebrovasc Dis, 2018, 27(9): 2534-2537.
21
章凯敏, 杜希剑, 管汉雄, 等. 远隔性小脑出血CT表现 [J]. 放射学实践, 2013, 28(1): 38-41.
22
中华医学会神经外科学分会, 中国医师协会急诊医师分会, 国家卫生和计划生育委员会脑卒中筛查与防治工程委员会. 自发性脑出血诊断治疗中国多学科专家共识 [J]. 中华急诊医学杂志, 2015, 24(12): 1319-1323.
23
Singh SD, Brouwers HB, Senff JR, et al. Haematoma evacuation in cerebellar intracerebral haemorrhage: systematic review [J]. J Neurol Neurosurg Psychiatry, 2020, 91(1): 82-87.
24
陈海秀, 刘智, 宋娟. 自发性小脑出血的外科治疗 [J]. 国际脑血管病杂志, 2020, 28(4): 309-313.
25
Al-Kawaz MN, Hanley DF, Ziai W. Advances in therapeutic approaches for spontaneous intracerebral hemorrhage [J]. Neurotherapeutics, 2020, 17(4): 1757-1767.
26
de Oliveira Manoel AL. Surgery for spontaneous intracerebral hemorrhage [J]. Crit Care, 2020, 24(1): 45.
27
Beniwal M, Kandregula S, Aravind, et al. Pediatric cerebral proliferative angiopathy presenting infratentorial hemorrhage [J]. Childs Nerv Syst, 2020, 36(2): 429-433.
28
Quick-Weller J, Brawanski N, Dinc N, et al. Stereotactic biopsy of cerebellar lesions: straight versus oblique frame positioning [J]. Br J Neurosurg, 2018, 32(2): 210-213.
29
Rychen J, O'Neill A, Lai LT, et al. Natural history and surgical management of spontaneous intracerebral hemorrhage: a systematic review [J]. J Neurosurg Sci, 2020, 64(6): 558-570.
30
Balasa A, Ghiga D, Andone RS, et al. Effects of surgery on the 30-day survival rate in spontaneous supratentorial intracerebral hemorrhage [J]. Brain Sci, 2020, 11(1): 5.
31
Khattar NK, Fortuny EM, Wessell AP, et al. Minimally invasive surgery for spontaneous cerebellar hemorrhage: a multicenter study [J]. World Neurosurg, 2019, 129: e35-e39.
32
Li M, Mu F, Han Q, et al. Intraventricular fibrinolytic for the treatment of intraventricular hemorrhage: a network meta-analysis [J] .Brain Inj, 2020, 34(7): 864-870.
33
Lau JC, Kosteniuk SE, Walker T, et al. Operative complications with and without image guidance: a systematic review and meta-analysis of the ommaya reservoir literature [J]. World Neurosurg, 2019, 122: 404-414.
34
于广久, 米山, 郑玲莉, 等. Ommaya囊辅助侧脑室穿刺引流术在高血压小脑出血治疗中的应用 [J]. 临床神经外科杂志, 2015, 12(1): 68-70.
35
Xiao T, Wan J, Qu H, et al. Endoscopic surgery versus minimal puncture drainage surgery for treatment of supratentorial intracerebral hemorrhage [J]. Turk Neurosurg, 2020, 30(4): 565-572.
36
张严国, 罗明, 闵强, 等. 导航辅助下神经内镜手术治疗高血压性小脑出血33例 [J]. 中国临床神经外科杂志, 2019, 24(4): 234-235.
37
Wang J, Wu QY, Du CP, et al. Spontaneous cerebellar hemorrhage with severe brainstem dysfunction through minimally invasive puncture treatment by locating the simple bedside [J]. Medicine (Baltimore), 2019, 98(38): e17211.
38
Li L, Liu H, Luo J, et al. Comparison of long-term outcomes of endoscopic and minimally invasive catheter evacuation for the treatment of spontaneous cerebellar hemorrhage [J]. Transl Stroke Res, 2021, 12(1): 57-64.
39
Xia L, Han Q, Ni XY, et al. Different techniques of minimally invasive craniopuncture for the treatment of hypertensive intracerebral hemorrhage [J]. World Neurosurg, 2019, 126: e888-e894.
40
Mao Y, Shen Z, Zhu H, et al. Observation on therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage [J]. Ann Palliat Med, 2020, 9(2): 339-345.
41
柴宏伟. 软通道颅内血肿清除术治疗高龄小脑出血 [J]. 中国实用神经疾病杂志, 2018, 21(14): 1583-1586.
42
Ho YN, Hsu SY, Lin YT, et al. Predictive factors of neurologic deterioration in patients with spontaneous cerebellar hemorrhage: a retrospective analysis [J]. BMC Neurol, 2019, 19(1): 81.
43
Sviri GE, Hayek S, Paldor I. Spontaneous cerebellar hemorrhage carries a grim prognosis in both operated and unoperated patients [J]. J Clin Neurosci, 2020, 78: 121-127.
44
Kuramatsu JB, Biffi A, Gerner ST, et al. Association of surgical hematoma evacuation vs conservative treatment with functional outcome in patients with cerebellar intracerebral hemorrhage [J]. JAMA, 2019, 322(14): 1392-1403.
45
Satopää J, Meretoja A, Koivunen RJ, et al. Treatment of intracerebellar haemorrhage: poor outcome and high long-term mortality [J]. Surg Neurol Int, 2017, 8: 272.
46
Wu YT, Li TY, Chiang SL, et al. Predictors of first-week mortality in patients with acute spontaneous cerebellar hemorrhage [J]. Cerebellum, 2013, 12(2): 165-170.
47
Dahdaleh NS, Dlouhy BJ, Viljoen SV, et al. Clinical and radiographic predictors of neurological outcome following posterior fossa decompression for spontaneous cerebellar hemorrhage [J]. J Clin Neurosci, 2012, 19(9): 1236-1241.
48
Pradhan RR, Shrestha GS, Sedain G. Remote supratentorial subdural hematoma following craniectomy and evacuation of hypertensive cerebellar hematoma [J]. Cureus, 2020, 12(2): e6977.
49
Gilligan J, Gologorsky Y. Cerebellar intracerebral hemorrhage treatment: better evidence-based studies needed [J]. World Neurosurg, 2020, 134: 656-657.
[1] 张晓宇, 殷雨来, 张银旭. 阿帕替尼联合新辅助化疗对三阴性乳腺癌的疗效及预后分析[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 346-352.
[2] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[3] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[4] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[5] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[6] 张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[7] 李伟, 宋子健, 赖衍成, 周睿, 吴涵, 邓龙昕, 陈锐. 人工智能应用于前列腺癌患者预后预测的研究现状及展望[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 541-546.
[8] 陈樽, 王平, 金华, 周美玲, 李青青, 黄永刚. 肌肉减少症预测结直肠癌术后切口疝发生的应用研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 639-644.
[9] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[10] 董佳, 王坤, 张莉. 预后营养指数结合免疫球蛋白、血糖及甲胎蛋白对HBV 相关慢加急性肝衰竭患者治疗后预后不良的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 555-559.
[11] 刘郁, 段绍斌, 丁志翔, 史志涛. miR-34a-5p 在结肠癌患者的表达及其与临床特征及预后的相关性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 485-490.
[12] 陈倩倩, 袁晨, 刘基, 尹婷婷. 多层螺旋CT 参数、癌胚抗原、错配修复基因及病理指标对结直肠癌预后的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 507-511.
[13] 曾明芬, 王艳. 急性胰腺炎合并脂肪肝患者CT 与彩色多普勒超声诊断参数与其病情和预后的关联性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 531-535.
[14] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[15] 郭曌蓉, 王歆光, 刘毅强, 何英剑, 王立泽, 杨飏, 汪星, 曹威, 谷重山, 范铁, 李金锋, 范照青. 不同亚型乳腺叶状肿瘤的临床病理特征及预后危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 524-532.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?