What are the treatments for cerebral hemorrhage?

1. The first aid principle of acute cerebral hemorrhage is ①preventing further bleeding; ②reducing intracranial pressure; ③controlling cerebral edema; ④maintaining vital functions and preventing complications. Specific measures are:

(1)Quiet bed: elevate the head of the bed and minimize moving. Generally bedridden for about 3 to 4 weeks.

(2) Ensure a smooth airway: the first 5min of cerebral hemorrhage is crucial for life. As the patient's tongue root falls back and easily blocks the respiratory tract causing asphyxiation, the respiratory tract should be guaranteed to be open: loosen the collar, remove the denture, lie on the side, tilt the head back, so as to facilitate the oral secretion to flow out by itself, and remove the oral vomit in time, and once asphyxiation, pull out the mouth as soon as possible, and carry out artificial respiration.

(3) rational application of sedative drugs: the restless or epileptic, the application of sedative, antispasmodic and analgesic drugs.

(4)Adjustment of blood pressure: for cerebral hemorrhage with high blood pressure, small amount of reserpine (reserpine) can be used to treat or 25% magnesium sulfate 10 ml, deep intramuscular injection; clear consciousness is given to oral antihypertensive drugs.

(5) less moving: if the patient in a small place onset, as soon as possible to try to move to a spacious place. The principle is to try not to vibrate the head, keep the head horizontal position moving, so as not to block the airway.

(6) Internal medicine treatment: hematoma is small and there is no obvious increase in intracranial pressure, basically to the basic treatment of internal medicine, sometimes can be increased at an early stage to improve the cerebral blood circulation of the drug, more often used to have blood circulation and eliminate blood stasis of the Chinese medicine preparations. Patients with concomitant cerebral edema and increased intracranial pressure need active and rational dehydration therapy.

(7) Surgical treatment: Most of the patients with large hematoma and obvious displacement of midline structures need timely surgery. Sometimes in order to rescue critically ill patients, emergency surgery should be performed. Some scholars believe that in the pathological damage to play a key role in the initiation and hematoma, the volume of ischemic edema caused by ischemia can be several times the volume of the hematoma, it is advocated that early surgery, even within 6h of the onset of the early surgery, can maximize the reduction of secondary damage, improve the success rate of salvage, reduce the rate of disability, and thus obtain a better therapeutic effect.

(8) Hemostatic drugs: commonly used phenolsulfonyl ethylamine (hemostatic), aminomethylbenzoic acid (antifibrinolytic arylate), vitamin K and so on. The dosage of hemostatic drugs should not be too large, the type should not be more.

(9) Strengthen nursing care and keep the airway open: turn over regularly and pat the back to prevent pneumonia and decubitus ulcers. Focus on dynamic observation of vital signs, including consciousness, pupil, blood pressure, pulse, respiration, every half hour to measure once, after stabilization can be 2 ~ 4h to measure once, and carefully recorded.

(10)Timely rescue: if the consciousness disorder is aggravated or restlessness, double pupils are not equal, slow reaction to light, slow pulse, blood pressure rises, it means that brain hernia has occurred, and should be rescued immediately.

2. Acute general treatment

(1) keep the airway open: comatose patients can take the head side position, should not be supine position, in order to prevent the tongue fall back and block the airway. Turn over and pat the back in time to facilitate sputum coughing out, and at the same time diligently suction sputum, can also be nebulized inhalation, in order to facilitate the wetting of sputum, signs of respiratory obstruction should be tracheotomy in time in order to avoid aggravation of cerebral edema due to hypoxia. Oxygen mixed with 5% carbon dioxide can be inhaled, intermittent inhalation is appropriate, try to avoid inhalation of pure oxygen for too long, because pure oxygen can lead to cerebral vasospasm, and even oxygen toxicity.

(2)Maintain nutritional and water-electrolyte balance: usually fasting in the first 1-2 days of the disease is good, the amount of fluids per day to 1500-2000ml is appropriate, and record the amount of in and out of the application of high-dose dehydrating agent, must pay attention to the potassium supplementation. In addition, attention should be paid to preventing and correcting acidosis, non-ketotic diabetes mellitus, hyperosmolar coma. For those who are comatose or unable to eat, a gastric tube can be inserted on the 3rd day for nasal feeding of fluids to ensure nutritional supply. Appropriately limit the amount of fluid intake, generally should not exceed 2500ml per day, such as high fever, vomiting, excessive sweating, excessive diuresis can be increased as appropriate. Avoid the use of high-sugar fluids, and give fat emulsion injection (fat milk), human blood albumin, amino acids or energy combinations when necessary.

(3) Strengthen nursing care: patients with cerebral hemorrhage have acute onset, critical condition, and high mortality rate. Therefore, nursing care in the acute stage is crucial. ①Closely observe the condition: including the state of consciousness, pupil changes, vomiting, monitoring blood pressure and temperature changes. ② Prevention of complications: the main factor affecting the treatment and prognosis of acute cerebrovascular disease is the prevention of complications. Preventing urinary tract infection and preventing decubitus ulcers is the focus of nursing care.

3. Adjustment of blood pressure in hypertensive cerebral hemorrhage patients of early antihypertensive treatment is based on the following principles:

(1) careful control of antihypertensive treatment indications, it is generally believed that in the systolic blood pressure more than 24 ~ 26.66kPa (180 ~ 200mmHg), can be considered to appropriately lower the blood pressure, in order to prevent further hemorrhage, but for the patients with too large a pulse pressure should be cautious to lower the blood pressure.

(2) Blood pressure should be controlled steadily, so that the "peak" and "trough" of blood pressure in 24h are close to each other, so as to avoid the damage of blood pressure fluctuation on blood vessel wall, and also to prevent insufficient cerebral perfusion that may be caused by too low blood pressure. Antihypertensive treatment should not pursue rapid antihypertensive effects, or repeated, large amounts, or even the combined use of a variety of potent antihypertensive drugs. Commonly used reserpine (reserpine) 0.5 ~ 1mg, intramuscular injection, 25% magnesium sulfate 10mg deep intramuscular injection, 6 ~ 12h can be repeated. Can also be used, such as converting enzyme inhibitors and other oral antihypertensive drugs or diuretics, but strong vasodilator drugs should be used with caution or not, when the patient's response to antihypertensive completely insensitive, then we must pay attention to intracranial hypertension caused by increased blood pressure.

(3) Do not lower the blood pressure too quickly, the more feasible way is to gradually lower the blood pressure to the above level or slightly higher over a period of time without the discomfort of cerebral ischemia is appropriate. Most people believe that the blood pressure should be stabilized at about 20-21.33/12-13.33kPa (150-160/90-100mmHg), and it is best to maintain it at a slightly higher level than the patient's original blood pressure.

(4) While using dehydration, diuretics and other drugs to reduce cranial pressure and anti-brain edema treatment, blood pressure, peripheral circulation and water and electrolyte balance must be closely observed. Especially furosemide (tachycardia), can indirectly make the brain tissue dehydration and through the inhibition of edematous tissue sodium into the cell, and reduce cerebral edema, as a rescue of patients with cerebral edema dehydration has been widely used, but continuous use of large doses of the drug caused by the continuous drop in blood pressure, blood volume plummeted, and water, electrolyte disorders, must be given sufficient attention.

(5) In the application of antihypertensive drugs at the same time, attention should be paid to observe the changes in blood pressure. When the blood pressure is too high, the head of the bed should be elevated about 30°～45°. When the blood pressure is close to normal . Lower the head of the bed. If the blood pressure is persistently too low, appropriate blood pressure-raising drugs should be used to maintain the above level.

4. Control of cerebral edema to reduce intracranial pressure is an important part of preventing the formation of cerebral hernia. After cerebral hemorrhage, cerebral edema is gradually aggravated, and edema often begins to appear in 6 h. It reaches the peak in 3~4 days and gradually subsides after half a month. The result of cerebral edema is the increase of intracranial pressure, even leading to the occurrence of cerebral hernia, so the control of cerebral edema and intracranial hypertension is the key to reduce the morbidity and mortality rate. Active measures should be taken promptly to control cerebral edema. When the use of dehydration is indicated in clinical practice, intravenous or intramuscular injection is generally used, unless the patient is awake, the increase in intracranial pressure is not serious and there is no vomiting, oral medication can be used. When intravenous or oral administration is difficult, rectal drip may also be considered, and 20% glycerol or 30% mannitol may be used. In the case of severe water loss and intracranial hypertension, intracarotid injection of mannitol 40 to 60 ml can be tried, which can achieve dehydration of brain tissue with less systemic effects. At the same time, the choice of dehydrating agent and its dosage must be considered according to the degree of increased intracranial pressure and cardiac and renal function and other systemic conditions. In case of deeper coma or early signs of brain herniation, strong dehydrating agents must be used. Usually, two to three alternating agents should be selected, such as 20% mannitol, furosemide (tachycardia), glycerol-based preparations. In the presence of cardiac or renal insufficiency, furosemide (tachyphylaxis) must often be used first. Colloidal fluids, such as 20% or 25% human albumin, can prevent a decrease in blood volume and avoid hypotension.

Adrenocorticotropic hormones applied in the acute phase help reduce cerebral edema. Adrenocorticotropic hormone to dexamethasone anti-brain edema effect is the strongest, especially for vasogenic brain edema, the common amount of 10 ~ 15mg added to glucose solution or mannitol, intravenous drip, 1 ~ 2 weeks to reduce the amount of hormone to discontinue, the role of the hormone is relatively slow, due to the brain hemorrhage of the comatose people are more prone to combined with gastrointestinal hemorrhage and lung infections, may be aggravated by the use of adrenocorticotropic hormone or cover up the condition, coupled with hormone The effect of reducing intracranial pressure is slow, and it can't rapidly resist cerebral edema, so it is not advocated to use it routinely, especially those with diabetes mellitus, hypertension, and ulcer disease should use it cautiously or prohibit it. Because it is easy to induce stress gastric hemorrhage, should be used simultaneously with gastric mucosa protection drugs.

5. The application of hemostatic drugs in patients with cerebral hemorrhage, whether the application of hemostatic drugs, so far, the view is different, a variety of hemostatic drugs can mainly stop the cerebral parenchyma capillary hemorrhage or oozing blood, for the arterial rupture of hemorrhage caused by the role of can not be sure.

Blindly applying hemostatic drugs to patients with atherosclerosis may increase the risk of ischemic cerebrovascular disease, myocardial infarction or renal artery thrombosis. Therefore, some people are against the use of hemostatic drugs, for those who have gastrointestinal bleeding can be used hemostatic drugs, but we should always check the coagulation function, in the relevant laboratory indicators under the supervision of short-term use of drugs. For those whose cerebral hemorrhage breaks into the ventricle or subarachnoid space, the application of appropriate hemostatic drug therapy can be considered to prevent rebleeding.

6. Artificial hibernation and cooling therapy artificial hibernation therapy can reduce the brain's basal metabolic rate, reduce oxygen consumption, so that the brain's tolerance to hypoxia increases, thus improving the state of cerebral hypoxia, reducing cerebral edema, lowering the intracranial pressure, the cerebral tissues have a protective effect, but also to reduce or avoid the occurrence of rebleeding.

(1) Early hypothermia: try to be given within 6h of the onset of the disease, more than 7~8h brain protection effect is poor. The cooling time is not more than 48 h. The time can be prolonged if complicated with high fever.

(2) Cooling methods: there are many cooling methods, and it is necessary to set up an advanced hypothermia room. If the conditions are limited, the method of head ice cap + aorta ice + drugs can be used.

(3)The principle of gradual rewarming: first stop using drugs, then withdraw the ice packs, and finally remove the ice cap, which can be completed in 8~12h; this short-term hypothermia rarely has complications, some of which appear to be muscle fibrillation and irritability, and can be used to give atracurium (cardiac myosin) 25mg or valium 10mg.

7.Surgical treatment: Due to the wide application of CT in the clinic, the diagnosis of hypertensive cerebral hemorrhage has become rapid and accurate. With the development of microsurgery, stereotactic surgery and other technologies, the accuracy of surgery has been improved, and the trauma to the brain tissue has been greatly reduced, so the indications for surgery for hypertensive cerebral hemorrhage are constantly being broadened.

It is generally believed that hematoma is formed within 6h after the onset of the disease, and the edema reaches its peak 8 to 24h after the hemorrhage, and better functional recovery may be obtained by removing the hematoma before this time. Early surgery can not only remove the hematoma in time to solve the intracranial hypertension, but also reduce the destruction of brain tissue by blood decomposition products, which is important to reduce the rate of death and disability.

(1) Surgical indications: There is no uniform standard for surgical indications in the surgical treatment of hypertensive cerebral hemorrhage so far. It is generally believed that patients are not particularly old, have good function of important organs, have no serious complications such as deep coma, gastrointestinal bleeding, decorticate tonus, double pupil constriction and central hyperthermia, etc., and meet one of the following conditions: ① those with bleeding volume of more than 20ml. ② Thalamic or basal nucleus hematoma. If the hematoma breaks into the ventricle, it should be drained by ventricular puncture as early as possible, and at the same time, lumbar puncture should be performed 1 time/d, and cerebrospinal fluid should be released 10-20ml each time until the condition stabilizes, and the drain tube should be kept under strict aseptic operation for about 1 week. ④ Hematoma involving the brain stem as well as those with advanced age or brain hernia should not be operated. ⑤ Those whose blood pressure is too high before surgery can lower their blood pressure first. ⑥ Those with vascular malformation or ruptured aneurysm should be cautious. (7) Cerebellar hemisphere hemorrhage is about 20ml. (8) Conservative internal medicine treatment does not improve, the condition gradually aggravated, or the appearance of cerebral hernia precursor.

(2) The timing of surgery: In the past, it was believed that patients with cerebral hemorrhage were in critical condition in the early stage of the disease, and the surgery was dangerous, with the risk of rebleeding, and the surgery should be carried out after 24h. In recent years, studies have shown that hypertensive cerebral hemorrhage generally forms hematoma in half an hour of hemorrhage, edema around the hematoma has not yet formed in 3h, 6-7h hemorrhage stops and there is perihematoma edema, necrosis of brain tissues immediately adjacent to the hematoma, irreversible damage occurs, moderate edema is achieved in 12h, and severe edema is achieved in 24h, with the in-depth study, most scholars advocate early or ultra-early surgery, i.e., 6-8h of morbidity Surgery can be performed before the edema occurs in the brain tissue around the hematoma, which can not only relieve the compression of the hematoma on the brain tissue, but also avoid the occurrence of cerebral edema, break the vicious circle caused by a series of secondary changes such as decomposition of blood cells and edema of the brain tissue after hemorrhage, and improve the survival rate and quality of life. Generally, it is appropriate to operate within 3 days after hemorrhage. Whether to use puncture for those who have been bleeding for more than 20 days should be determined on a case-by-case basis.

(3) Surgical methods: commonly used methods of hematoma removal surgery are: ① neuroendoscopic treatment techniques; ② minimally invasive surgery for hypertensive cerebral hemorrhage; ③ bone flap or bone window craniectomy for hematoma removal; ④ CT-guided stereotactic suction treatment; ⑤ ventricular drainage and hematoma lysis.

8. Recovery treatment of cerebral hemorrhageThe purpose of recovery treatment is to promote functional recovery of paralyzed limbs and speech disorders, to improve brain function, to reduce sequelae and to prevent recurrence. The timing of recovery treatment is when the brain lesion is basically stabilized, the clinical symptoms of cerebral edema and intracranial hypertension subside, and the damaged brain function is gradually recovered. In this period, in addition to the original internal medicine treatment, the focus should be on improving cerebral blood circulation and promoting nutrient metabolism, and attention should be paid to the gradual selection of drugs to dilate cerebral blood vessels. The effect of drugs should be gentle, starting with a low dose and gradually increasing to the therapeutic amount, or gradually increasing the type of drugs from one to another. Another important therapeutic measure during the recovery period is rehabilitation therapy, especially for patients with severe neurological deficits such as hemiplegia and aphasia, which should be started as early as possible and carried out step by step in order to obtain better results and significantly reduce disability.

(1) Preventing rebleeding: Recurrent cerebral hemorrhage is one of the major causes of death and disability among survivors of cerebrovascular disease. Domestically, Song Degen et al. reported that the interval of recurrent cerebral hemorrhage was from 3 months to 5 years, accounting for 19.5% (58/297) of cerebral hemorrhages in the same period. 37.9% recurred within 1 year after the first attack, 75.8% within 2 years, and 93% within 3 years, i.e., the vast majority of patients recurred within 3 years.

On the causative factors of rebleeding, Passeros et al. used a combined variable analysis to show that the risk factors for recurrent cerebrovascular disease were not significantly related to age, gender, hyperlipidemia, smoking, heavy alcohol consumption, and diabetes mellitus, and that the key factors were uncontrolled hypertension and vascular amyloidosis.

The results of the domestic study by Song Degen et al. concluded that the triggers of rebleeding were mostly hypertension, followed by mood changes such as agitation and sadness, and diabetes mellitus. Elderly rebleeding often have a history of TIA or ischemic cerebrovascular disease, hyperlipidemia rebleeding is less. Therefore, active control of hypertension, rational treatment of diabetes mellitus, and attention to self-regulation of emotions, regular life, moderate diet, and timely treatment of constipation are important links in the prevention of recurrent cerebral hemorrhage. Regarding the regression of rebleeding, Song Degen et al. reported that 58 cases were treated with internal medicine, 29 cases improved and 29 cases died, each accounting for 50% of the number of patients.

(2) Drug therapy:

①Calcium channel antagonists: after cerebral hemorrhage, the brain tissue around the hematoma ischemia, hypoxia, and the nerve cells in the lesion are in calcium overload state, and the application of calcium channel antagonists can alleviate the overload state to prevent the death of the cells, improve the microcirculation of the brain, and increase the supply of cerebral blood flow. Commonly used drugs are: nimodipine (Nidal), 20-40mg, 3 times / d; or nimodipine (Nimotop), 30mg, 3 times / d; Guillotine (Cerebral Ezine), 25mg, 3 times / d. Hypotension, cerebral edema is obvious, and increased intracranial pressure should be used with caution.

② brain metabolism activator: can choose to promote neurometabolism drugs, such as piracetam (brain Fukang), cytarabine (cytarabine), cerebral protein hydrolysate (cerebral viability), γ-amino tyrosine, pan-decanolone (coenzyme Q10), vitamin B, vitamin E, and vasodilator drugs, but also can be used to activate the blood and eliminate blood stasis, qi, such as the prescription.

(3) Dietary control:

1) Nutrient-rich and easy-to-digest foods should be supplied to meet the body's needs for protein, vitamins, inorganic salts and total calories.

②Drink more water and often eat semi-fluid food, because paralyzed patients often have the fear of urinating more and try to drink less water, which is not good for patients. Daily meals should also have rice and soup, especially to often eat porridge is appropriate, but also appropriate to eat some salty dishes, in order to drink more water. For a few people who do not want to drink water, you can eat some juicy fresh fruits and vegetables to prevent constipation and urinary tract infectious diseases.

3 attention to dietary fiber supply. Food should not be too fine to prevent the occurrence of constipation. Avoid strong tea, alcohol, coffee and spicy stimulating food.

④Salt and cholesterol intake should be controlled and foods rich in B vitamins should be increased.

(4) Rehabilitation therapy:

①Passive exercise and massage: when the patient's limb has no muscle strength, passive exercise should be the main focus, the movement should be gentle, gentle, and rhythmic joint by joint, to ensure that all the joints full range of motion. It should be done 2 times a day, 3 times each time. In order to maintain the motor function of joints and soft tissues, to prevent limitation of the range of motion due to contracture, while joint contracture will lead to local blood circulation disorder and aggravate the difficulty of rehabilitation. When the patient's limb appears to function, it gradually turns to a combination of active and passive movements. Passive movement should pay special attention to the abduction and external rotation of the shoulder joint on the affected side to prevent shoulder contracture pain.

②Active exercise: After the patient's limbs have muscle strength, active exercise should be carried out in a timely manner.

Bed active activities and sitting up training: some patients with cerebrovascular disease initially regard themselves as the paralysis of the whole limb, not just one side of the paralysis, and feel that the whole body is completely weak. The first way to overcome this feeling is to help patients learn to use the healthy side of the limbs to move the body in bed, and at the same time can be supine limb extension and flexion movements. The head of the bed should be raised as early as possible when the patient is awake. To tolerate this better, sitting in bed for limb function exercise, such as pulling the rope to pull things, practice sit-ups, supine stretching, lifting the leg so that the tight muscles are powerful pull, in order to increase the range of activities.

Bedside exercise: patients should gradually learn to sit up on the bedside, the method is that the patient can be curled up on the healthy side, and then the healthy side of the lower limbs placed under the lower limbs of the affected side, so that the affected limbs from the edge of the bed down, with the healthy side of the upper limbs to support the sitting up. At this time, the patient is to use the visual afferent and the healthy side of the upper limb of the proprioceptive afferent to fully learn and train the sitting balance, after learning to sit balance, standing balance learning is much easier.

Standing exercise: after exercising at the bedside, create conditions in time to achieve self-supporting or self-supporting against the wall, and then leave the bed for indoor and outdoor activities.

3 Physiotherapy and acupuncture.

④Medical sports therapy: the coordination of the body is due to frequent and repeated training, when the limbs are paralyzed, the coordination will be lost. Therefore, before completing each complex coordinated movement, one must have the ability to perform each simple decomposed movement. Only gradual, persistent repetitive training from simple to complex can make these muscles part of normal activity. For paralyzed muscle groups through the active-assisted, active, active resistance to gravity and resistance and other exercises and make progress in each group of muscles, from simple to complex, through many repetitions of physical exercise, will make the function of the limbs gradually coordinated.

9. Stroke unit treatment model of cerebrovascular disease

(1)What is a stroke unit: A stroke unit (strokeunit) is a stroke treatment management model that provides stroke patients with relevant systematic medication, physical rehabilitation, language training, psychological rehabilitation, and health education. The core staff of a stroke unit consists of clinicians, specialized nurses, physiotherapists, occupational therapists, speech and language trainers, and social workers.

From the above concepts, the characteristics of a stroke unit can be summarized as follows:

1) It is aimed at hospitalized stroke patients, so it is not a green channel for emergency care, nor is it the whole management of stroke, but only the management of the patient during hospitalization.

②The stroke unit is not a therapy but a ward management system in which new treatments are not included.

③This new ward management system should be a multidisciplinarycaresystem, that is, a close multidisciplinary cooperation.

④Patients should receive rehabilitation and health education in addition to medication. However, a stroke unit is not equal to medication plus rehabilitation; it is a special type of integratedeare or organizedcare.

5 The stroke unit reflects humanistic care for patients and human-centeredness, which takes the functional prognosis of patients and the satisfaction of patients and families as important clinical goals, unlike the treatment in traditional wards which only emphasizes the recovery of neurological function and improvement of imaging.

(2) Stroke units can be divided into the following 4 basic types:

①Acute stroke unit (acutestrokeunit): admitting and treating patients in the acute phase, usually within 1 week of the onset of the disease. In this type of stroke unit, supervision is emphasized, and the patient is hospitalized for a few days, usually not more than 1 week.

②Rehabilitation stroke unit (rehabilitationstrokeunit): admitted to patients 1 week after the onset of the disease, due to the stabilization of the condition, more emphasis on rehabilitation. Patients are hospitalized for several weeks or even months.

3 joint stroke unit (combinedacuteandrehabilitationstrokeunit): also known as perfect stroke unit (comprehensivestrokeunit), joint acute and rehabilitation **** the same function. Admits patients in the acute phase, but hospitalized for several weeks, which can be extended to several months if needed.

4 Mobile stroke unit (mobilestrokeunit): also known as mobile stroke team (mobilestroketeam), in this model there is no fixed ward, the patient is admitted to a different ward, a multidisciplinary medical team to check the room and develop a medical plan, so there is no fixed nursing team. Some authors have argued that this form is not a stroke unit but a stroke team (stroketeam).

(3) All stroke patients should be treated in a stroke unit: Stroke units are a common form of stroke care, and the establishment of a stroke unit is not difficult, so it is necessary to emphasize that all patients must be admitted to a stroke unit for treatment.

To promote stroke units, national stroke guidelines emphasize the need for admission of patients in the acute phase to a stroke unit, with the recent Royal Society of Medicine (2000), European Stroke Advocacy (2000), and American Stroke Association (2003) guidelines emphasizing, in particular, the necessity of admission (e.g., to a stroke unit, to early intervention in rehabilitation, to a multimodal care team).

The operation of the Beijing Organized Stroke Care System (BOCSS), which was initiated in 2002, will greatly contribute to the improvement of the level of stroke care in China and bring it closer to the international system.

(II) Prognosis

When the bleeding is small and the site is shallow, the hematoma usually starts to dissolve naturally after 1 week, and the blood clot is gradually absorbed. Cerebral edema and increased intracranial pressure are gradually reduced, and the patient gradually becomes conscious. Eventually, a small number of patients recover well, while the majority of patients are left with varying degrees of hemiparesis and aphasia.

1. Prognostic factors

(1) Large hematoma, severe brain tissue destruction, has caused sustained intracranial pressure increase.

(2) Obvious impairment of consciousness.

(3) Upper gastrointestinal bleeding.

(4) Brain hernia formation.

(5) Centralized hyperthermia.

(6) Decorticate tonus.

(7) Elderly patients over 70 years of age.

(8) Complications of respiratory or urinary tract infection.

(9) Recurrent cerebral hemorrhage.

(10) High or low blood pressure and cardiac insufficiency. These patients can be life-threatening or left with severe limb paralysis or prolonged impaired consciousness.

2. Factors affecting the morbidity and mortality of hypertensive atherosclerotic cerebral hemorrhage patients

(1) Generally, older age is associated with higher morbidity and mortality. Therefore, a positive and cautious attitude should be taken for the treatment of cerebral hemorrhage in the elderly.

(2) High mortality rates are associated with severe underlying diseases and comorbidities. Pre-existing atherosclerosis, diabetes mellitus, coronary heart disease, emphysema, etc., their vital organs have poor reserve function, reduced stress and defense ability, and are prone to multi-organ failure, with a high morbidity and mortality rate. Complicated infections, electrolyte, acid-base imbalance, hypovolemic state and medical factors during treatment and morbidity seriously affect the normal metabolism of all major organs and make their functions decline.

(3) Infection is one of the main causes of multi-organ failure and death, so the rational application of antibiotics to control infection is the key to preventing and treating multi-organ failure.

(4) Combined upper gastrointestinal hemorrhage is an important indicator of the severity of the disease. Combined upper gastrointestinal bleeding patients with increased morbidity and mortality. The latter may be the most dangerous factor leading to upper gastrointestinal hemorrhage in those with a history of gastric disease, especially if the hematoma breaks into the ventricle.

(5) The death of patients with cerebral hemorrhage is significantly related to the location of the hemorrhage, the size of the hemorrhage, and the accumulation of blood in the cerebral ventricles. The larger the hemorrhage, the more severe the compression on the surrounding brain tissues, and the more pronounced the cerebral edema and the increase in intracranial pressure, which can easily cause the midline structure to shift and the brainstem to be compressed, resulting in the formation of cerebral hernia and death.

(6) The accumulation of more blood in the third and fourth ventricles will cause obstruction of the midbrain conduit, triggering acute obstructive hydrocephalus, exacerbating cranial hypertension and cerebral edema. At the same time, bloody cerebrospinal fluid can also directly stimulate the lower thalamus, causing neuroendocrine dysfunction leading to hyperthermia, upper gastrointestinal hemorrhage, cerebro-cardiac syndrome, hyperglycemia and other complications.

(7) Hematocrit in the fourth ventricle can also cause dilatation of the fourth ventricle, which directly compresses the brainstem and leads to cerebral hernia or respiratory arrest.

(8) The death rate of those whose hematoma breaks into the ventricle is significantly higher than that of those whose hematoma does not break into the ventricle, and the death rate of those with total ventricular casts is even higher. If the hematoma breaks into the ventricle and the blood clot blocks the cerebrospinal fluid pathway, hematoma removal plus continuous ventricular drainage should be performed, which can greatly reduce the morbidity and mortality rate.

(9) The immediate cause of death in the early stage of cerebral hemorrhage is mainly cerebral herniation, therefore, rapid and effective relief of cerebral compression and acute cranial hypertension is the key to successful treatment. When the occupying effect is aggravated by hemorrhage and/or edema, which leads to the deterioration of neurological function, aggressive therapeutic measures need to be used.

(10) Comprehensive therapeutic measures: In the treatment of patients with cerebral hemorrhage, in order to reduce the morbidity and mortality rate, in addition to actively treating the primary disease, should also be comprehensive treatment, make up for the daily calories, prevention and treatment of upper gastrointestinal hemorrhage, acute renal failure, secondary infections, and other complications, to maintain the respiratory, blood volume, and cardiorespiratory function stability, the regulation of blood pressure is also very important.