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2013年脑卒中指南:修改的和新的建议摘要(第二部分:介入治疗)
原作者: Feng Xiao, MD (肖锋) 文章来源: 中华急诊医学杂志编辑部 发布日期:2013-03-14

Title: 2013 Stroke Guidelines: Revised and New Recommendations (Part 2: Interventions)
题目:2013年脑卒中指南:修改的和新的建议摘要(第二部分:介入治疗)

7. Intravenous Fibrinolysis 静脉溶栓
Eligible patients should receive rtPA therapy as soon as possible, ideally within 60 minutes of hospital arrival.
有适应症的病人应尽快接受tPA治疗,最理想的是在到达医院后60分钟内。
IV fibrinolysis can be considered in patients with rapidly improving symptoms, mild stroke deficits, major surgery within the past 3 months, and recent myocardial infarction.
下列情况也可以考虑应用静脉溶栓:症状很快改善,轻度的脑梗塞症状,过去的3个月内做过小手术,和近期心梗。
The effectiveness of sonothrombolysis for treatment of patients with acute stroke is not well established.
超声溶栓在治疗急性脑卒中中的效果还不清楚。
rtPA is not recommended in patients taking direct thrombin inhibitors or direct factor Xa inhibitors unless tests including activated partial thromboplastin time, INR, platelet count, clotting time, thrombin time, or direct factor Xa activity are normal; or they haven't taken these agents for > 2 days.
如病人使用直接凝血酶或Xa因子抑制剂,不要用tPA,除非下列检查正常或病人两天以上没有用这些药:部分活性凝血酶源时间,INR,血小板计数,凝血时间,凝血酶时间,或直接Xa因子活性。
8. Endovascular Interventions 血管内介入治疗
Select patients with MCA strokes of < 6 hours duration who are not IV rtPA candidates can benefit from intra-arterial fibrinolysis.
对于发病6个小时内不适于静脉tPA的大脑中动脉脑梗卒中病人,可以考虑用动脉内溶栓。
Minimizing delays in administering intra-arterial fibrinolysis improves outcomes.
缩短拖延动脉内溶栓可以改善预后。
Stent retrievers are preferred to coil retrievers.
支架取栓要优于线圈取栓。
In patients with a large artery stroke who have not responded to IV fibrinolysis, intra-arterial fibrinolysis and mechanical thrombectomy are reasonable approaches.
如病人患有大动脉脑卒中又对静脉溶栓无效,可以考虑用动脉内溶栓或机械取栓术。
Emergent intracranial angioplasty and/or shunting do not have proven usefulness, nor does the use of these approaches in the extracranial carotid or vertebral arteries in unselected patients.
紧急颅内血管扩张和/或分流没有明确的临床效果,它们在颅外颈动脉或椎动脉中的应用也是一样。
Reference 参考文献:
Edward C. Jauch, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947.

Reference 参考文献:
Edward C. Jauch, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947.

http://www.ncbi.nlm.nih.gov/pubmed/23370205

文章来源:中华急诊医学杂志编辑部