2013AHAASA指南学习2.pptVIP

14. Supplemental oxygen is not recommended in nonhypoxic patients with acute ischemic stroke (Class III; Level of Evidence B). (Unchanged from the previous guideline) Intravenous fibrinolysis 1. Intravenous rtPA (0.9 mg/kg, maximum dose 90 mg) is recommended for selected patients who may be treated within 3 hours of onset of ischemic stroke (Class I; Level of Evidence A). Physicians should review the criteria outlined in Tables 10 and11 (which are modeled on those used in the NINDS Trial) to determine the eligibility of the patient. A recommended regimen for observation and treatment of patients who receive intravenous rtPA is described in Table 12. (Unchanged from the previous guideline) Inclusion criteria Diagnosis of ischemic stroke causing measurable neurological deficit Onset of symptoms 3 hours before beginning treatment Aged ≥18 years Exclusion criteria Significant head trauma or prior stroke in previous 3 months (原来：NO) Symptoms suggest subarachnoid hemorrhage Arterial puncture at noncompressible site in previous 7 days History of previous intracranial hemorrhage Intracranial neoplasm, arteriovenous malformation, or aneurysm （增加） Recent intracranial or intraspinal surgery （增加） Elevated blood pressure (systolic 185 mm Hg or diastolic 110 mm Hg) Active internal bleeding（增加） Acute bleeding diathesis, including but not limited to Platelet count 100 000/mm3 Heparin received within 48 hours, resulting in abnormally elevated aPTT greater than the upper limit of normal Current use of anticoagulant with INR 1.7 or PT 15 seconds Current use of direct thrombin inhibitors or direct factor Xa inhibitors with elevated sensitive laboratory tests (such as aPTT, INR, platelet count, and ECT; TT; or appropriate factor Xa activity assays)增加 Blood glucose concentration 50 mg/dL (2.7 mmol/L) CT demonstrates multilobar infarction (hypodensity 1/3 cerebral hemisphere) Relative exclusion cri