A 54-year-old man with a history of hypertension is admitted to the ICU forevaluation of a left basal ganglia intracerebral hemorrhage measuring 45 mL and intraventricular hemorrhage. There is evidence of early onset of obstructive hydrocephalus. On admission, his Glasgow Coma Scale score is 6, and he is intubated for mechanical ventilation. He also has a right hemiplegia with extensor posturing. Blood pressure is 198/109 mm Hg, heart rate 109 beats/min, and respiratory rate 24 breaths/min. He has mild obesity.
Which of the following interventions could potentially improve his chance of survival?
A. Intraventricular tissue plasminogen activator
B. Lowering systolic blood pressure to less than 140 mm Hg
C. Hypothermia (core temperature 35°C [95°F])
D. Antiseizure medication for seven days
E. Insertion of an external ventricular drain
答案解析：
脑出血 (ICH) 是迄今为止最具破坏性的中风形式。 除了在专门的中风或神经 ICU 中进行管理外，没有任何特定的药物疗法能够持续改善 ICH 后的预后。 通气支持、血压控制、任何先前存在的凝血障碍的逆转、颅内压监测、渗透疗法、发热控制、癫痫预防、高血糖治疗和营养补充是 ICU 支持治疗的基石。 对于所有出现脑室内血液和急性脑积水的昏迷或昏迷患者，应紧急进行脑室引流。 在这种情况下，尽早放置心室引流管可能会挽救患者的生命。
正确答案：E
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