缺血性脑血管病的抗栓治疗.ppt

缺血性卒中抗血小板药物分层选择 极高危 支架或其他形术 动脉-动脉栓塞事件 阿司匹林+氯比格雷 高危 缺血性卒中或TIA， 氯比格雷 1.动脉粥样应硬化狭窄 2.有重要危险因素（糖尿病、CHD、代谢综合症，持续吸烟 ） 中危 缺血性卒中或TIA， 阿司匹林或氯比格雷 低危 只有危险因素的高危人群 阿司匹林 脑梗死是人类健康的巨大威胁，根据WHO2002年的数据，全球每年死亡人口中脑梗死（卒中）占10％，共550万人，是全世界第三位死亡原因。我国更加严重，每年因卒中死亡165万人，居世界首位。 Background and Purpose—To examine the incidence and trends of stroke and its major subtypes during the 1990s in 3 cities in China. Methods—Stroke cases registered between 1991 to 2000 were initially identified through the stroke surveillance networks established in Beijing, Shanghai, and Changsha, and then confirmed by neurologists. Results—The age-standardized incidence rates per 100 000 person years of overall first-ever stroke were 135.0 (95% CI, 126.5 to 144.6) in Beijing, 76.1 (70.6 to 82.6) in Shanghai, and 150.0 (141.3 to 160.0) in Changsha during the 1990s. Incidence of ischemic stroke (IS) was highest in Beijing, followed by Changsha and Shanghai; for intracerebral hemorrhage (ICH), the highest rate was found in Changsha, followed by Beijing and Shanghai. The same order as ICH was also observed for subarachnoid hemorrhage. The age-adjusted incidence of overall stroke and ICH for individuals 55 years of age in our populations was generally higher than that from Western populations. During the 1990s, ICH incidence decreased significantly at a rate of 12.0% per year in Beijing, 4.4% in Shanghai, and 7.7% in Changsha; in contrast, except for Changsha, IS incidence increased in Beijing (5.0% per year) and Shanghai (7.7%). Conclusions—There is a geographic variation in the incidence of stroke and its subtypes among these 3 cities, but the incidence of overall and hemorrhagic stroke in China is generally higher than that in the Western countries. Interestingly, the decrease in ICH and increase in IS during the past decade may reflect some underlying chan