1. If the clinical manifestations of acute cerebral hemorrhage occur during dialysis, the anticoagulant infusion should be stopped immediately and the machine should be removed quickly.
2. For hemodialysis patients who diagnose acute cerebral hemorrhage, it is recommended to transfer to the stroke unit or neurology monitoring room for treatment. The patient's respiratory, oxygen inhalation, temperature control and blood sugar control are the same as those of non-dialysis patients.
3. Patients with large cerebral hemorrhage accompanied by cerebral edema, elevated intracranial pressure (predicted bleeding volume > 30 ml) or ventricular hemorrhage should evaluate the indications for surgical emergency surgery, and the surgical indications are those of non-dialysis patients.
4. Intracranial hypertension treatment for patients with acute cerebral hemorrhage caused by hemodialysis is recommended for intravenous injection of glycerol fructose. However, after injecting glycerol fructose intravenously, water cannot be eliminated from the urine, which can increase circulating blood volume; therefore, it is recommended to use glycerol fructose during dialysis.
5. It is recommended to actively control blood pressure from the acute phase
(1) Patients with systolic blood pressure >180mmHg or average arterial pressure >130mmHg, it is recommended that the previous value of blood pressure 80% is used as the target of lowering blood pressure, and slowly lowering blood pressure; systolic blood pressure <140mmHg helps prevent the hematoma from expanding. Antihypertensive drugs are selected for nicardipine, diltiazepine hydrochloride, nitroglycerin and sodium nitroprusside intravenous infusion.
(2) To prevent recurrence of cerebral hemorrhage, it is recommended to control diastolic pressure <90mmHg.
(3) Prevent the occurrence of cerebral hemorrhage and control blood pressure <140/90mmHg is beneficial.
6. The incidence of microcerebellar hemorrhage in patients with long-term hypertension or previous cerebrovascular diseases is 19% to 35%. SWI examination is recommended for this type of patients, and CT angiography, MRI contrast-free angiography, and digital subtraction angiography are performed when necessary to detect potential vascular lesions such as intracranial arteriovenous malformations and hemangiomas.
7. Hemodialysis treatment for acute cerebral hemorrhage in patients with hemodialysis
(1) Avoid hemodialysis within 24 hours of acute cerebral hemorrhage.
(2) Select dialysis methods that affect less intracranial pressure in the early stage of onset: ① Continuous hemodialysis filtration; ② Peritoneal dialysis; ③ Daily inefficient and slow hemodialysis.
(3) Glycerol fructose is given intravenous injection during dialysis, combined with ultrafiltration treatment to reduce intracranial pressure.
(4) Citrate can be used for local anticoagulant. Warfarin is discontinued and vitamin K is given; protamine antagonism is given in patients who use warfarin or low molecular weight heparin.