缺血性脑卒中急性期的护理研究进展

综述国内外缺血性脑卒中急性期的救治现状、救治延迟的相关因素及其策略、围溶栓期的护理等,并提出参考性建议,旨在为我国缺血性脑卒中急性期患者提供更有效的护理借鉴.     

超急性期缺血性脑卒中的影像学诊断进展

缺血性脑卒中超急性期是指出现临床症状和体征6～8h内,由于此时缺血的细胞尚处于可逆性阶段,动脉局部溶栓可以迅速起效,及时恢复血流能获得临床上完全治愈的好效果.常规CT及常规MRI虽然可以诊断一部分超急性期缺血性脑卒中,但它们不能显示闭塞部位脑组织的灌注情况,也不能显示脑血流侧支循环,提供缺血脑组织的病理信息很少,不能很好地指导溶栓治疗.以下着重介绍对超急性期缺血性脑卒中诊断有重要价值的现代影像检查技术.     

高压氧治疗对急性期缺血性脑卒中偏瘫患者的临床观察

<正>缺血性脑卒中是临床常见的脑血管病变,最常见的临床表现是运动的障碍如偏瘫,病人一侧身体和手脚不灵活、无力,甚至不能活动;或一侧身体和手脚感觉麻木。如何更好和更快地恢复患者的肢体功能使其早日回归社会和家庭,已经成为患者、家属甚至我们许多医生的困惑。     

脑卒中急性期康复治疗的疗效观察

1资料与方法 1．1一般资料 2005年1月-12月在我院神经内科病房住院治疗的急性脑卒中患者65例．均符合1995年第四届全国脑血管病学术会议的诊断标准，均经头部CT证实为脑梗死或脑出血。[第一段]     

缺血性脑卒中治疗原则

缺血性脑卒中 (ＩＳ)是常见病、多发病 ,由于病因和临床情况复杂 ,在治疗上尚没有一个广泛适用而有效的疗法。目前治疗药物多 ,治疗方法也很多 ,有的还存有争议 ,下面将认识上一致的处理原则和治疗方法作一简述。1　脑梗死急性期的一般治疗纵观国内外的动向 ,凡在有条件的地方都强调设立卒中监护病房 ,由有经验的医护人员积极救治与有效的检测仪器相结合对提高疗效、降低死亡率十分有利。我们应该向这一方向努力。急性期的一般处理包括呼吸功能维持与对并发症的防治。有意识障碍的病人给予气道支持 ,检测ＰａＯ2 和ＰａＣＯ2 ,注意调控血压 …     

脑卒中急性期他汀治疗不可停

停用他汀者早期神经学功能恶化危险增加8倍,90天死亡或残疾危险增加4倍。西班牙Santiago de Compostela大学医院Blanco等报告,在缺血性脑卒中急性期停用他汀类药物治疗,会增加90天时死亡和残疾危险。[Neurology 2007,69(9):904]215例脑半球缺血性卒中患者在发病24小时内就诊,研究者将其中89例长期接受他汀类药物治疗者随机分为二组,组1(46例)患者入院后最初3天停用他汀类药物,组2(43例)患者入院后则立即进行阿伐他汀20 mg/d治疗。主要转归事件为3个月时的死亡或残疾[改良Rankin评分(mRS)>2]。结果显示,与组2相比,组1患者90天时mRS>2比例…     

急性缺血性脑卒中溶栓治疗现状

脑卒中与心肌梗死、恶性肿瘤并列为致死率最高的疾病之一．且致残率又高于后二。多年以来,急性脑梗死的常规治疗中始终没有一种方法被证实有确实可靠的疗效。随着相关病理生理学发展,新型神经影像学的发展．以及局灶性脑缺血中心坏死区周围存在的可塑性损伤区域一半影区的发现,为早期恢复血灌使缺血脑组织受益,并缩小梗死范围。因此．人们在长期寻求的急性脑梗死的治疗方面有所突破。     

缺血性脑卒中的二级预防策略及急性期降压治疗

脑卒中具有高患病率、高病死率、高致残率和高复发率的特点,是一种严重危害人类健康的全球性问题。缺血性脑卒中占所有类型脑卒中的85％左右。复发性脑卒中较首次发生的脑卒中更易导致严重的致残,预后也更差。迄今为止,人们对脑卒中的病因与发病机制尚不能做出全面的、科学的阐述;对已发生的脑卒中也做不出令人满意的治疗,甚至难于影响其自然病程和结局。因此,脑卒中的二级预防在预防卒中复发中显得尤为重要。     

Factors determining headache at onset of acute ischemic stroke

Headache is a frequent accompaniment of acute ischaemic stroke. The predisposing factors and underlying mechanisms are currently incompletely defined. We analysed prospectively collected data relevant to headache occurring at ischaemic stroke onset in consecutive patients included in the Henry Ford Hospital Stroke Data Bank. Patients with headache (HA+) and without headache (HA-) were compared for demographic factors, medical history, medications, examination findings, laboratory findings, and stroke localization and subtype. Group comparisons for categorical data were performed with chi(2) test, and for continuous variables with two-sample t-tests. Stepwise logistic regression analysis, including all variables with P<0.25, was used to define the independent predictors of onset headache. Three hundred and seventy-five patients had complete headache and clinical datasets and were included in the analysis (HA+, N=118; HA-, N=257). Multivariate analysis revealed that the independent predictors of HA+ were: infarct in the distribution of the posterior circulation [P=0.0076, odds ratio (OR) 2.15, 95% confidence interval (CI) 1.23, 3.77], absence of history of hypertension (P=0.0106, OR 0.48, 95% CI 0.27, 0.84), and treatment with warfarin at the time of the index stroke (P=0.0135, OR 4.89, 95% CI 1.39, 17.21). The occurrence of headache at onset of ischaemic stroke is determined by posterior circulation distribution of the ischaemic event, absence of history of hypertension and treatment with warfarin at the time of the index stroke. These results suggest that preserved elasticity and maintenance of the intracranial vasculature in a relaxed state, in combination with coagulation system derangements, and activation of dense perivascular afferent nerves, play a role in the pathogenesis of onset headache.     

Treatment of acute ischemic stroke: intravenous and endovascular therapies

Stroke is the third most common cause of death in the USA, following heart disease and cancer. Intravenous recombinant tissue plasminogen activator is the only US FDA-approved pharmacological treatment available today for acute ischemic stroke. Despite the approval of this drug, it has been underutilized in the community. The limited time window of 3 h disqualifies many patients from receiving the drug. In addition, fears of intracranial hemorrhage have resulted in underutilization of the drug in the community setting. Efforts to increase the time window of treatment include utilization of the intra-arterial route for delivery of a thrombolytic drug and interventional mechanical strategies. In this article, we review the major intravenous and intra-arterial thrombolysis trials and review the mechanical strategies being developed to treat patients with acute ischemic stroke.     

Management of acute ischemic stroke

The treatment of acute ischemic stroke has evolved from observation and the passage of time dictating outcome to an approach that emphasizes time from ictus, rapid response, and a dedicated treatment team. We review the treatment of acute ischemic stroke from the prehospital setting, to the emergency department, to the inpatient hospital setting. We discuss the importance of prehospital assessment and treatment, including the use of elements of the neurologic examination, recognition of symptoms that can mimic those of acute ischemic stroke, and rapid transport of patients who are potential candidates for thrombolytic therapy to hospitals with that capability. Coordinated management of acute ischemic stroke in the emergency department is critical as well, beginning with non-contrast-enhanced computed tomography of the brain. The advantages of a multidisciplinary dedicated stroke team are discussed, as are thrombolytic therapy and other inpatient treatment options. Finally, we cover evolving management strategies, treatments, and tools that could improve patient outcomes.     

针刺足三里和悬钟治疗缺血性脑卒中

目的:观察针刺足三里、悬钟2穴对缺血性脑卒中脑血管功能的影响,分析其可能的作用机制,并对临床疗效做出评价。方法:选择2004-11/2006-05湖北中医药高等专科学校附属古城医院针灸科、荆州市第五人民医院中医康复科、荆州市第三人民医院中医科3单位缺血性脑卒中患者合适病例160例,采用查随机数字表的方法,将其随机分为对照组和针刺组,各80例。对照组采用现代医学常规干预方法进行治疗:卧床,保持呼吸道通畅,预防感染,控制颅内压、血压,维持水电解质平衡。针刺组在此基础上加针刺足三里、悬钟2穴,采用慢速捻转进针法针刺,留针20～30min,每隔5min行针1次。1次/d。两组患者治疗30d。并以经颅多普勒检测观察缺血性脑卒中患者治疗前后脑血管舒缩反应能力、脑血流自动调节功能、大脑半球侧枝循环代偿功能的变化,同时以治疗前后神经功能缺损程度为指标评价其临床疗效。结果:160例病例全部进入结果分析。①针刺组与治疗前相比,脑血管舒缩反应能力明显加强,差异有显著性意义(t=2.97,P<0.05),且优于对照组(t=2.45,P<0.05)。②针刺组与治疗前相比,脑血流自动调节能力明显改善,差异有非常显著性意义(t=8.01,P<0.01),且优于对照组(t=7.67,P<0.05)。③针刺组与治疗前相比,大脑半球侧枝循环代偿功能得到加强,差异有显著性意义(t=3.15,P<0.05),且优于对照组(t=5.16,P<0.05)。④针刺组与治疗前相比,神经功能缺损积分明显降低,差异有非常显著性意义(t=4.83,P<0.01),且优于对照组(t=5.43,P<0.05)。结论:针刺足三里、悬钟2穴对缺血性脑卒中患者脑血管舒缩反应能力、脑血流自动调节功能、大脑半球侧枝循环代偿功能有明显改善作用,并能促进神经功能的恢复。     

高密度脂蛋白对缺血性脑卒中急性期患者外周血中免疫细胞分布的影响

目的分析高密度脂蛋白(HDL)对缺血性脑卒中急性期患者外周血中免疫细胞分布的影响。方法纳入42例就诊于首都医科大学宣武医院的急性缺血性脑卒中患者为研究对象,所有患者发病至就诊时间均≤7 d。入院后治疗前均采集血标本,检测外周血中HDL的表达水平,应用流式细胞仪检测外周血中免疫细胞的百分比。根据HDL表达水平的不同将患者分为HDL1.0 mmol/L组(n=22)和HDL≥1.0 mmol/L组(n=20)。结果 HDL1.0 mmol/L组外周血中CD3~+T淋巴细胞、CD3~+CD4~+T淋巴细胞百分比高于HDL≥1.0 mmol/L组,但CD3~+CD8~+T淋巴细胞百分比低于HDL≥1.0 mmol/L组,差异均有统计学意义(P0.05)。2组患者外周血中单核细胞百分比差异无统计学意义(P0.05)。结论在缺血性脑卒中急性期患者中,较高水平的HDL常伴有低水平的CD3~+、CD3~+CD4~+T淋巴细胞的募集,这种结果可能有利于减少缺血性卒中后的脑组织损伤。     

Alteplase for acute ischemic stroke

Alteplase, an intravenously administered form of recombinant tissue plasminogen activator (rt-PA), remains the only US FDA-approved thrombolytic treatment for acute ischemic stroke within 3 h of symptom onset. Patients treated with intravenous rt-PA are at least 30% more likely to have minimal or no disability at 3 months compared with placebo. Despite an increased risk of symptomatic intracranial hemorrhage, rt-PA does not increase mortality. The benefit achieved with rt-PA is cost effective and sustained 1 year after treatment. Despite its clear benefit, rt-PA remains underutilized. Although the future of acute ischemic stroke treatment will most likely involve a multi-faceted treatment approach, the primary objective remains to establish recanalization of the involved vessel. For patients with acute ischemic stroke within the first 3 h of symptom onset, rt-PA remains the first step in accomplishing this goal.     

Thrombolysis for acute ischemic stroke

Data generated from randomized controlled trials in the last decade have shown that acute intervention can improve neurologic outcome in patients with ischemic stroke. This article reviews recent studies of systemic and intra-arterial thrombolysis for cerebrovascular disease in detail. Important considerations for treating patients with thrombolysis are explored, and theoretic and practical differences in the approach to patients with anterior and posterior circulation disease are highlighted.