加拿大阿尔伯塔省卒中策略——卒中二级预防

<正> 缺血性卒中和短暂性脑缺血发作(transient ischemic attacks,TIA)患者再发卒中和其他血管事件的风险增加。TIA发生卒中的风险很高。TIA患者90d内发生卒中的风险为10%～20%。其中50%的患者是在2 d(48 h)内发生卒中。复发卒中比初发卒中更有可能致残和致死。20%～40%卒中患者病前有TIA或非致残卒中。卒中二级预防的重点在于阻止或推延高危人群的未来疾病事件,实现功能和临床症状的改善,促进健康和提高生活质量。幸运的是,有足够的证据显示:通过改变生活方式、管理血管危险因素和适当药物治疗来大大减少再发卒中的危险。     

卒中

本栏目中卒中与成人卒中指南来自美国心脏学会2005年1月23～30日在堪萨斯州达拉斯举办的2005年心肺复苏及急诊心血管疾病治疗共识会议(Circulation,2005,112:Ⅲ-110-Ⅲ-114)。     

Stroke

In this paper I propose a theoretical framework for the treatment of patients with self-care problems. This framework takes as its starting point the frequent countertransference “pulls” encountered with such patients toward what might be called concerned action—the impulse to intervene actively in a protective or directive way in the hope of fostering better self-care. I suggest that, rather than simply acting on these impulses, on one hand, or viewing them as projectively or intersubjectively induced impulses simply to be processed internally by the analyst for purposes of interpretation, on the other, we view such impulses as the opening of a paradoxical or dialectical potential space in the transference–countertransference relationship. I argue that self-care problems result from the breakdown of a central dialectic in the parent–child relationship between concerned action and empathic recognition and that it is this dialectic that must be reestablished and reworked in the treatment relationship.     

Stroke：急性缺血性卒中血管内再通治疗工作流程新进展

<正>对于行血管内治疗的急性缺血性卒中患者,提供最佳的诊断过程和快速的血管内治疗需要急救医疗服务(emergencymedical service,EMS)人员、急诊科医师、卒中医师、神经介入医师和麻醉医师的密切合作。2019年Stroke杂志新发表的一项系统性回顾和荟萃分析探讨了对于急性缺血性卒中患者救治,特定的工作流程改进对快速行血管内治疗的效果。这些具体的工作流程改进内容如下:     

European Stroke Initiative Recommendations for Stroke Management-update 2003

This article represents the update of 'European Stroke Initiative Recommendations for Stroke Management', first published in this Journal in 2000. The recommendations are endorsed by the 3 European societies which are represented in the European Stroke Initiative: the European Stroke Council, the European Neurological Society and the European Federation of Neurological Societies.     

Stroke rehabilitation

Based on the number of patients involved, stroke dominates the field of neurologic rehabilitation. The prevalence of stroke in the United States population is 1.4 million. This represents a prevalence for stroke of 612 per 100,000 population, compared with 157 for Parkinson's disease, 50 for spinal-cord injury, 42 for multiple sclerosis, and 16 for head-injured survivors with neurologic sequelae. This article provides an overview of stroke rehabilitation and covers patient management for the acute phase, subacute phase, and chronic phase poststroke. Medical and nursing care are discussed throughout and physical, occupational, and speech therapy for patients in these three phases are explored.     

Stroke prevention

Stroke prevention is a crucial issue because (i) stroke is a frequent and severe disorder, and (ii) acute stroke therapies that are effective at the individual level have only a little impact in term of public health. Stroke prevention consists of the combination of 3 strategies: an optimal management of vascular risk factors, associated when appropriate with antithrombotic therapies, carotid surgery, or both. Primary prevention trials have shown that reducing blood pressure in hypertensive subjects reduces their vascular risk, including stroke. The association of perindopril plus indapamide reduces the vascular risk in patients who have had a stroke or TIA during the last 5 years, irrespective of their baseline blood pressure. Lowering serum cholesterol with statins or gemfibrozil in patients with hypercholesterolemia or coronary heart disease (CHD), reduces the risk of stroke. However, no trial of cholesterol-lowering therapy has been completed in stroke patients. A strict control of high cholesterol levels should be encouraged, because of benefits in terms of CHD. Statins should be prescribed for stroke patients with CHD, or increased cholesterol levels. Cigarette smoking is associated with an increased risk of stroke and should be avoided. Careful control of all risk factors, especially arterial hypertension in type 1 and type 2 diabetics is recommended, together with a strict glycemic control to reduce systemic microvascular complications. Estrogens prescribed in hormone replacement or oral contraceptive therapies are not recommended after an ischemic stroke. It is also recommended to reduce alcohol consumption and obesity, and to increase physical activity in patients at risk for first-ever or recurrent stroke. An optimal management of risk factors for stroke is crucial to reduce the risks of first-ever stroke, recurrent stroke, any vascular event after stroke and vascular death. One of the major public health issues for the coming years will be to focus more on risk factor recognition and management. Received: 29 November 2001, Accepted: 7 December 2001     

DNA甲基化架起危险因素与卒中的桥梁

<正>脑血管病是全球范围内致残和致死最主要的慢性病之一。全球疾病负担(global burden of disease,GBD)研究结果显示,2019年我国卒中患者已高达2876万,其中新发卒中394万例,卒中死亡病例219万例,是影响我国伤残调整生命年(disability-adjusted life years,DALYs)的首位原因^[1]。目前,已发现与卒中相关的危险因素,如高血压、糖尿病、高脂血症等,与环境因素密切相关。因此,进一步探究环境因素相关的分子调控机制可能有助于了解危险因素促进卒中发生和发展的机制,     

Pediatric Stroke

Pediatric stroke is relatively rare but may lead to significant morbidity and mortality. Along with the advance of brain imaging technology and clinical awareness, diagnosis of pediatric stroke is increasing wordwide. Pediatric stroke differs from adults in variable risk factor/etiologies, diverse and nonspecific clinical presentation depending on ages. This review will be discussed pediatric stroke focusing on their clinical presentations, diagnosis and etiologies/risk factors.