短暂性脑缺血分层策略教程方案.ppt

Talking Points This study investigated the short-term risk of stroke and other adverse events in 1,707  patients after emergency department diagnosis of TIA. During the 90 days after index TIA, a total of 428 patients (25.1%) experienced a stroke or  other adverse events. (red bar) This included strokes (10.5%), recurrent TIAs (12.7%), cardiovascular events (2.6%)  and deaths (2.6%).(15) (yellow bars) Background The study results indicate that the short-term risk of stroke, other adverse events and deaths among patients who present to an emergency department with a TIA is substantial.(15) Half of the strokes occurred within 2 days of the TIA. Short-term risks of cardiovascular events, death, and recurrent TIA were also high.(15) Currently available interventions for patients with TIA may not be cost-effective if used in all such patients. This study identified 5 independent risk factors for stroke within 90 days after TIA: age older than 60 years, diabetes mellitus, duration of episode greater than 10 minutes, and weakness and speech impairment with the episode. These risk factors may identify patients whose symptoms are more likely due to cerebral ischemia or may indicate pathophysiological conditions associated with greater risk.(15) 短暂性脑缺血发作危险等级分层策略 短暂性脑缺血发作（TIA） 好发中年以后，男：女=2：1 短暂、局限性脑功能障碍 突然发生?消失 数分钟?数十分钟 24小时缓解、不遗留症状和体征 1/4-1/5病人发展为完全性脑卒中 另外：可逆性缺血性脑损害（reversible ischemic neurologic deficit，RIND） 主要内容 TIA的危害 TIA定义的演变 TIA的风险分级策略 TIA的急诊应对 一、TIA的危害 TIA有进展为缺血性卒中的风险 是脑梗死的先兆症状 也是治疗干预的最佳时机 Post-TIA (%) 4 – 8 12 – 13 24 – 29 30 days 1 year 5 years Post-Stroke (%) 3 – 10 5 – 14 25 – 40 Sacco. Neurology. 1997;49(suppl 4):S39. Feinberg et al. Stroke. 1994;25:1320. TIA或中风后再中风风险 TIA后7天内是中风的高风险期 急诊室诊断TIA后的短期（90天）预后 Johnston SC, et al. JAMA 2000;284:2901-2906. 10.5% 12.7% 2.6% 2.6% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% Stroke Recurrent TIA CV event Death Outcome events Inclusion criteria: Objective:Outcome measures: Total events: T