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目的:脑出血后神经功能恶化与出血后继发水肿及多种神经损伤机制有关,是一个多重因素相互作用的复杂的病理生理过程,认识其相关脑出血后神经损伤的多种机制,为脑出血的康复干预治疗提供理论依据。资料来源:应用计算机检索Medline数据库1991-01/2003-12期间的文章,检索词为“hemorrhagicstroke,cerebralhemorrhage,brainedema,nervoussysteminjury”分别组合进行检索,限定文章语言种类为英文。同时检索万方数据库2004-01/2005-01期间的相关文章,检索词“脑出血,脑水肿,神经系统损伤”,限定文章语言种类为中文。资料选择:对资料进行初筛,筛出与研究目的无关的文献。纳入标准:研究对象为动物或人,包括脑出血后继发脑水肿及神经损伤机制相关的基础与临床研究文献。重点选取与脑出血后继发脑水肿相关的文献。资料提炼:共收集到文献85篇,其中与本研究关系密切的文献22篇,间接相关的文献18篇,排除重复性文献9篇,共31篇文献用于资料的综述。资料综合:对于选取的文献进行阅读、归纳和综合。结果显示脑出血后血肿周围继发水肿及神经损伤是脑出血患者预后不良的重要影响因素。脑出血后继发水肿及神经损害有多种因素参与,血肿形成过程中的流体静力压和血凝块的回缩、凝血瀑布的激活、凝血酶的产生、红细胞溶解和血红蛋白的毒性、补体的激活、占位效应、血脑屏障的破坏、血肿周围继发缺血、血肿周围组织神经细胞炎症反应及细胞凋亡等。结论:针对脑出血后继发水肿及多种病理生理过程采取保护措施,有望改善脑出血后神经系统的损伤并改善其功能预后。
OBJECTIVE: The neurological deterioration after intracerebral hemorrhage is related to the secondary edema after hemorrhage and various nerve injury mechanisms. It is a complex pathophysiological process with multiple factors interacting. To understand the various mechanisms of neurological injury associated with intracerebral hemorrhage, Rehabilitation intervention to provide a theoretical basis. DATA SOURCES: A computer-based online search of the Medline database was conducted between January 1991 and December 2003 with the search term of “hemorrhagicstroke, cerebral hemorrhage, brainedema, nervoussysteminjury”, respectively. The article type was limited to English. Meanwhile, articles related to Wanfang Database from January 2004 to January 2005 were searched for the articles “cerebral hemorrhage, brain edema and nervous system damage”, and the article language was limited to Chinese. Data Selection: The data screening, screening out unrelated documents and research purposes. Inclusion criteria: The subjects were animal or human, including basic and clinical literature related to secondary brain edema and neuronal injury following cerebral hemorrhage. Focus on the selection and secondary cerebral edema after cerebral hemorrhage related literature. DATA EXTRACTION: A total of 85 literatures were collected, of which 22 were closely related to this study, 18 were indirect related documents, 9 were excluding repetitive documents, and 31 were used for the review of data. Data Synthesis: The selected documents for reading, induction and synthesis. The results showed that secondary hematoma and nerve injury around the hematoma after intracerebral hemorrhage are the important influencing factors of poor prognosis in patients with intracerebral hemorrhage. There are many factors involved in the secondary edema and nerve damage after intracerebral hemorrhage. Hydrostatic pressure and clot retraction during hematoma formation, coagulation cascade activation, thrombin generation, erythrocyte lysis and hemoglobin toxicity, complement Activation, occupying effect, the destruction of the blood-brain barrier, secondary ischemia around the hematoma, inflammatory reaction of the nerve cells around the hematoma and apoptosis. Conclusion: Protective measures against secondary edema and various pathophysiological processes after intracerebral hemorrhage are expected to improve the nervous system injury after cerebral hemorrhage and improve its functional prognosis.