Spontaneous intracerebral hemorrhage (ICH) results in high rates of morbidity and mortality, with intraventricular hemorrhage (IVH) being associated with even worse outcomes. Therapeutic interventions in acute ICH have continued to emerge with focus on arresting hemorrhage expansion, clot volume reduction of both intraventricular and parenchymal hematomas, and targeting perihematomal edema and inflammation. Large randomized controlled trials addressing the effectiveness of rapid blood pressure lowering, hemostatic therapy with platelet transfusion, and other clotting complexes and hematoma volume reduction using minimally invasive techniques have impacted clinical guidelines. We review the recent evolution in the management of acute spontaneous ICH, discussing which interventions have been shown to be safe and which may potentially improve outcomes.

自发性脑出血（ICH）导致高发病率和死亡率，而脑室内出血（IVH）则导致更糟糕的结果。急性脑出血的治疗干预措施不断涌现，重点是阻止出血扩大、减少脑室内和实质血肿的血块体积，以及针对血肿周围水肿和炎症。大型随机对照试验探讨了快速降低血压、输注血小板和其他凝血复合物的止血治疗以及使用微创技术减少血肿体积的有效性，这些试验影响了临床指南。我们回顾了急性自发性脑出血治疗的最新进展，讨论了哪些干预措施已被证明是安全的，哪些干预措施可能会改善结果。