Approximately 10%of the 795000 strokes per year in the United States are intracerebral hemorrhages(ICHs),defined by brain injury attributable to acute blood extravasation into the brain parenchyma from a ruptured cerebral blood vessel.The clinical impact of ICH appears disproportionately high among lower-resource populations both in the United States and internationally.In US-based studies,ICH incidence has been reported to be≈1.6-fold greater among Black than White people and 1.6-fold greater among Mexican American than nonHispanic White people.Internationally,ICH incidence is substantially higher in low-and middle-income versus high-income countries,both as a proportion of all strokes and in absolute incidence rates.

Several additional features of ICH make it a greater public health threat than conveyed by incidence numbers alone.ICH is arguably the deadliest form of acute stroke,with early-term mortality about 30%to 40%and no or minimal trend toward improvement over more recent time epochs.Incidence of ICH increases sharply with age and is therefore expected to remain substantial as the population ages,even with counterbalancing public health improvements in blood pressure(BP)control.Another growing source of ICH is more widespread use of anticoagulants,a trend likely to counterbalance the reduced ICH risk associated with increasing prescription of direct oral anticoagulants(DOACs)relative to vitamin K antagonists(VKAs).ICH thus remains in need of novel treatments and improved application of established approaches for every aspect of the disease:primary and secondary prevention,acute inpatient care,and poststroke rehabilitation and recovery.This guideline seeks to synthesize data in the ICH field into practical recommendations for clinical practice.

在美国每年795000例卒中中中中大约有10%是颅内出血 (ICHs) ,定义为急性血液从破裂的脑血管外渗到脑实质引起的脑损伤。在美国和国际上，ICH的临床影响在资源匮乏的人群中似乎不成比例地高。在基于美国的研究中，据报道，黑人的 ICH 发病率比白人高约1.6倍，墨西哥裔美国人的 ICH 发病率比非西班牙裔白人高1.6倍。在国际上，低收入和中等收入国家的 ICH 发病率比高得多，包括所有卒中的比例和绝对发病率。

ICH的几个额外特征使其成为比单独发病率更大的公共卫生威胁。ICH可以说是急性卒中最致命的形式，早期死亡率约为30%-40%，在最近的时间内没有或只有极小的改善趋势。ICH的发病率随着年龄的增长而急剧增加，因此随着人口老龄化，预期仍然是实质性的，即使在血压控制方面抵消了公共卫生的改善。ICH的另一个日益增长的来源是抗凝剂的广泛使用，相对于维生素 K 拮抗剂 (VKA)，这种趋势可能抵消了与直接口服抗凝剂 (DOAC) 处方增加相关的 ICH 风险降低。因此，ICH仍然需要新的治疗方法，并改善疾病每个方面的既定方法的应用：初级和二级预防、急性住院护理、卒中后康复和恢复。本指南试图将 ICH 领域的数据综合到临床实践的实际建议中。