Спонтанное внутримозговое кровоизлияние: распространённость, триггерные факторы, терапевтическое и хирургическое лечение

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Аннотация

Спонтанное внутримозговое кровоизлияние — второй по частоте подтип инсульта — является значительной причиной смертности и заболеваемости во всём мире. Триггерными факторами, «ускоряющими» наступление болезни, могут служить гипертония, чрезмерное употребление алкоголя и постоянное курение, гипохолестеринемия и некоторые принимаемые лекарственные препараты, принадлежность к мужскому полу и почтенный возраст, проживание в слаборазвитой стране и этническая составляющая, хронические заболевания почек, церебральная амилоидная ангиопатия и микрокровоизлияния.

Терапевтические решения при спонтанном внутримозговом кровоизлиянии направлены на остановку расширения кровоизлияния, уменьшение объёма сгустка как внутрижелудочковой, так и паренхимальной гематомы, на борьбу с перигематомальным отёком и воспалением, на быстрое снижение артериального давления. Используют также гемостатическую терапию с переливанием тромбоцитов и других свёртывающих комплексов.

Проводятся клинические испытания малоинвазивных методов хирургической эвакуации (эндоскопическая хирургия и стереотаксическая аспирация, инвазивная краниопунктура), которые могут дать положительные результаты из-за более короткого времени операции и использования местной анестезии. Методы малоинвазивной хирургии теоретически способны улучшить результаты открытого хирургического вмешательства (за счёт уменьшения повреждения коллатеральных тканей и сокращения времени анестезии), но они не могут быть полноценной их альтернативой.

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Кенан Сабухиевич Нифталиев

Воронежский государственный медицинский университет имени Н.Н. Бурденко

Автор, ответственный за переписку.
Email: niftaliev@yahoo.com
ORCID iD: 0000-0002-6996-4188
SPIN-код: 1877-7033
Россия, Воронеж

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