卒中并发静脉血栓栓塞的诊断与治疗

静脉血栓栓塞(Venous thromboembolism,VTE)是临床卒中后常见的并发症,主要包括深静脉血栓形成(Deep vein thrombosis,DVT)和肺栓塞(Pulmonary embolism,PE)。卒中急性期(发病2周内)DVT的发生率高达50%,多发生在瘫痪侧肢体,其危险度与肢体瘫痪程度、年龄呈正相关,此外,大约13%～25%的卒中患者早期死亡与合并PE有关,常常发生于卒中后第2～4周。     

关注卒中后静脉血栓栓塞

静脉血栓栓塞(简称VTE)临床表现有两种形式,即深静脉血栓(简称DVT或静脉炎)和肺栓塞(简称PE)。在美国,VTE症年新发病例为1/1000,其中1/3为PE, 2/3为DVT,PE和DVT往往并存。有研究显示50%被确诊为DVT的患者同时存在PE,而高达70%被确诊为PE的患者同时存在DVT。我国九五攻关课题“肺血栓栓塞早期诊断与防治”的研究结果显示:脑卒中后DVT的发病率为6．67%。详     

溶栓药物及机械装置治疗急性缺血性卒中的进展

卒中在美国是继心脏病和肿瘤之后的第3位致死原因,并且是世界范围内的一个主要致残原因。在过去的20年,卒中治疗方面有许多进展,主要集中在预防、急性期干预和减少相关死亡率方面。大多数急性期的干预目标是灌注不足和功能受损的脑组织(缺血半暗带)。缺血半暗带是指如果没有足够的、及时的脑血流供应将会发生不可逆性损伤的区     

卵圆孔未闭与缺血性卒中

1卵圆孔未闭与隐源性卒中的关系胎儿时期,肺不能接受血流,返回到右心房的血液是通过开放的卵圆孔分流至左心房的。出生后,约75%的人卵圆孔自动关闭,而25%的人发生卵圆孔未闭(patent foramen ovale, PFO)。卵圆孔未闭不影响血流动力学,正常情况下,卵圆窝膜可阻挡左向右的分流,当右房压力升高时,卵圆孔重新开放,为奇异性栓塞(如矛盾性栓塞,反常性栓塞,paradoxical embolism)提供了一个管道。     

机械溶栓能否降低成人急性缺血性卒中相关的死亡率和致残率?

1文献检索根据研究检索策略,共筛选10项关于机械溶栓有效性的研究,还有1项由一名专家确认符合入选标准但超出设定检索日期的研究。根据证据水平,系统剔除了1项病例对照研究,5项非对照病例报告研究以及3项试验设计不明确的研究,最后仅有2项平行     

积极稳妥地开展急性缺血性卒中的血管内治疗

<正>随着我国社会老龄化进程的加快,脑血管病发病率仍在增加,其病死率和病残率极高,造成极大的社会负担。我国每年有150~200万新发病例,其中约85%是缺血性卒中。我国在急性缺血性卒中(acute ischemic stroke,AIS)的规范化救治方面起步较晚,与欧美国家差距很大,许多病人错失治疗良机。令人欣慰的是,近年来越来越多的同道对这个问题给予重视,各地区各大医院相继成立脑血管病     

脑卒中后深静脉血栓形成的诊治

深静脉血栓形成(DVT)和继发性肺栓塞(PE)是卒中后主要并发症,是导致患者临床症状突然恶化或死亡的原因之一。早在20世纪60年代,欧美国家就已经开始关注脑卒中后DVT和PE的发生,近年来,我国对卒中后DVT和PE也高度重视。本文就脑卒中后DVT的发生率、危险因素、临床表现、诊断、预防及治疗等方面进行综述。     

急性缺血性卒中病因与早期弥散加权成像表现的关系

目的探讨缺血性卒中早期的影像学检查是否有助于判断病因。方法回顾性调查急性缺血性卒中患者226例,探讨早期的弥散加权成像(DWI)的影像学表现与病因的相关性。结果早期的DWI表现与病因有关(rs=-0.245,P=0.000)。其中,10例单发的皮质皮质下梗死(χ2=16.591,P=0.000)、17例多发的分水岭梗死(χ2=7.156,P=0.007)、39例散发性梗死(χ2=20.846,P=0.000)和17例位于前循环的多发性梗死(χ2=7.156,P=0.007),病因多为大血管病变;71例小的穿通支梗死病因多为小血管病变(χ2=174.308,P=0.000)。除此之外,还有相当一部分小穿通支梗死(12/71,16.90%)具有其他原因(χ2=7.112,P=0.008);大部分(13/18)皮质梗死病因不明(χ2=19.650,P=0.000)。结论缺血性卒中急性期的DWI检查可帮助确定病因。     

缺血性卒中或短暂性脑缺血发作的Ⅱ级预防指南

本文目的在于为预防卒中提供综合及时的循证医学建议,预防缺血性卒中患者或短暂性脑缺血发作患者发生缺血性卒中。循证医学建议包括控制危险因素、动脉粥样硬化的介入治疗、心源性脑栓塞的抗凝治疗、非心源性栓塞性卒中的抗血小板药物治疗,提出了一系列特定情况下防止卒中复发的建议,如动脉夹层、卵圆孔未闭、高同型半胱氨酸血症、高凝状态、镰状细胞病、脑静脉窦血栓形成、女性卒中特别是妊娠妇女及绝经后激素替代治疗及脑出血后如何使用抗凝药物等。     

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)。     

Risk of Venous Thromboembolism in Hospitalized Patients with Acute Ischemic Stroke Versus Other Neurological Conditions

BackgroundThe mechanism of increased risk of venous thromboembolism (VTE) after acute ischemic stroke (AIS) is unclear. In this study, we aimed to evaluate the risk of VTE in hospitalizations due to AIS as compared to those due to non-vascular neurological conditions. We also aimed to assess any potential association between VTE risk and the use of intravenous thrombolysis (rtPA) among hospitalizations with AIS.Materials and methodsIn this case-control study, data were obtained from the Nationwide Inpatient Sample 2016-2018. Propensity score matching was used to adjust for the baseline differences between the groups. Logistic regression analysis was used to compare the risk of VTE.ResultsWe identified 1,541,685 hospitalizations due to AIS and 1,453,520 hospitalizations due to non-vascular neurological diagnoses that served as controls. After propensity score matching, 640,560 cases with AIS and corresponding well-matched controls were obtained. Hospitalizations due to AIS had higher odds of VTE as compared to the controls [odds ratio (OR) 1.50, 95% confidence interval (CI) 1.40-1.60, P<0.001]. Among hospitalizations with AIS, 184,065 (11.9%) got rtPA. The odds of VTE were lower among the AIS hospitalizations that received rtPA as compared to those that did not (OR 0.89, 95% CI 0.79-0.99, P0.035).ConclusionHospitalizations due to AIS have a higher risk of VTE as compared to the non-vascular neurological controls. Among AIS cases, the risk of VTE is lower among patients treated with rtPA. These epidemiological findings support the hypothesis that the risk of VTE after AIS might be partly mediated by an intrinsic pro-coagulant state.     

Early Hyperchloremia and Outcomes After Acute Ischemic Stroke

ObjectiveBased on the relationship between hyperchloremia and mortality in critically ill patients, we investigated the effect of early hyperchloremia on 90-day outcomes in acute ischemic stroke patients.Materials and MethodsAcute ischemic stroke patients recruited within 5 h of symptom onset were analyzed. Hyperchloremia (defined as 110 mmol/L or greater) at either baseline, or 24, or 48 h after randomization was identified and classified as one occurrence or two or more occurrences. Logistic regression analyses were performed to determine the effects of hyperchloremia on: favorable outcomes (defined by a National Institutes of Health Stroke Scale and/or modified Rankin scale scores of 0-1) at 90-day, death or disability at 90-day, and death within 90-day after accounting for potential confounders.ResultsAmong the total of 1275 patients, one and two or more occurrence of hyperchloremia within 48 h were seen in 191 patients and 108 patients, respectively. Compared with patients without hyperchloremia, patients with two or more occurrences of hyperchloremia at significantly higher odds of lack of favorable outcomes (odds ratio 3.0, 95% confidence interval 1.8-5.1) and death or disability (odds ratio 2.6, 95% confidence interval 1.6-4.1) at 90-day after adjustment for age, National Institutes of Health Stroke Scale score strata (6-9, 10-19, ≥ 20), study intervention, initial SBP, and intra-arterial treatment.ConclusionsThe independent association between sustained hyperchloremia and lack of favorable outcomes at 90-day suggest that avoidance of hyperchloremia may reduce the rate of lack of favorable outcomes and death or disability in patients with acute ischemic stroke.     

Cardiac Rupture After Intravenous t-PA Administration in Acute Ischemic Stroke

Background  

Ventricular free wall rupture is a fatal complication of myocardial infarction (MI). Although described in MI patients who receive thrombolytic therapy, this complication is not well known in ischemic stroke patients who receive intravenous (IV) t-PA.     

缺血性卒中的一级预防指南

本指南由美国心脏病学会/美国卒中协会的卒中委员会颁布,由动脉粥样硬化性周围血管病多学科工作组、心血管病护理学会、临床心脏病学会、营养运动及代谢学会、医疗质量及结局研究多学科工作组联合发起。希望能对我国缺血性卒中的一级预防起到指导作用。