重视脑出血后缺血性事件的防治  

Pay attention to subsequent arterial ischemic events after intracerebral hemorrhage

作　　者：姜帅 吴波[1] Jiang Shuai;Wu Bo(Center of Cerebrovascular Diseases,Department of Neurology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院神经内科,四川大学华西医院脑血管病中心,成都610041

出　　处：《中华神经科杂志》2023年第1期6-14,共9页Chinese Journal of Neurology

基　　金：国家自然科学基金(81870937,82071320,82271328);中国博士后科学基金(2022M712249);四川省科技计划(2019YJ0037)。

摘　　要：脑出血后幸存者面临着出血复发和缺血性事件发生的双重风险, 因此脑出血后血管性事件的预防常常存在治疗矛盾。目前临床实践中重点关注了脑出血的复发, 而忽略了对缺血性事件的预防。如何权衡出血与缺血复发的风险、是否使用抗栓和他汀类药物以及何时启动治疗, 是脑出血后二级预防的棘手问题。文中将结合国内外研究进展, 系统梳理脑出血后继发缺血性事件诊治中的关键问题, 旨在促进临床医生和研究者对这一重要领域进行关注和探索。Survivors of intracerebral hemorrhage(ICH)have significantly higher risks of both arterial ischemic events and recurrent ICH after the first event.This uncertainty leaves clinicians with dilemmas about the therapy strategies for the secondary prevention of major vascular events after ICH.Clinicians mainly focus on the prevention of hemorrhage recurrence but overlook the increased risk of ischemic disease after ICH in routine clinical practice.Secondary stroke prevention measures after ICH including antithrombotic and statin treatments remain challenging due to the lack of dedicated studies with strong evidence.Decision-making on stroke prevention requires algorithmic approaches based on the hemorrhagic and ischemic risk stratification.This article systematically reviews the current evidence for the prevention and management of subsequent arterial ischemic events after ICH,aiming to promote further attention and research to address the current controversies and knowledge gap on this topic.

关 键 词：脑出血 缺血性事件 抗栓 他汀 预防 

分 类 号：R743.34[医药卫生—神经病学与精神病学]