蛛网膜下腔出血最新指南推荐2013(翻译).docVIP

Medical Measures to Prevent Rebleeding AfteraSAH: Recommendations 动脉瘤性蛛网膜下腔出血（aSAH）后预防再出血的药物推荐：1. Between the time of aSAH symptom onset andaneurysm obliteration, blood pressure should becontrolled with a titratable agent to balance the riskof stroke, hypertension-related rebleeding, andmaintenance of cerebral perfusion pressure (Class I;Level of Evidence B). (New recommendation) aSAH症状出现到动脉瘤处理后这段时间里，应使用容易调控的药物将血压在一定的水平，使卒中风险与高血压相关的再出血风险达到平衡，并保证足够的脑血管灌注压。（I级推荐，B级证据）（新的推荐）2. The magnitude of blood pressure control to reducethe risk of rebleeding has not been established, but adecrease in systolic blood pressure to 160 mm Hgis reasonable (Class IIa; Level of Evidence C). (Newrecommendation) 降低再出血风险应将血压降到什么程度尚没有定论，但是收缩压降至160mmHg以下是合理的。（IIa级推荐，C级证据）（新的推荐）3. For patients with an unavoidable delay in obliterationof aneurysm, a significant risk of rebleeding,and no compelling medical contraindications, shortterm(72 hours) therapy with tranexamic acid oraminocaproic acid is reasonable to reduce the risk ofearly aneurysm rebleeding (Class IIa; Level of EvidenceB). (Revised recommendation from previousguidelines) 如果患者因各种原因无法及时行动脉瘤阻断治疗，再出血风险大而没有明显药物禁忌症的情况下，短期应用(72小时)氨甲环酸或氨基己酸来降低早期再出血风险是合理的（IIa级推荐，B级证据）（修改了旧指南的推荐） Surgical and Endovascular Methods of Treatment of Ruptured Cerebral Aneurysms: Recommendations 破裂脑动脉瘤的外科和血管内治疗方法的推荐 1. Surgical clipping or endovascular coiling of the ruptured aneurysm should be performed as early as feasible in the majority of patients to reduce the rate of rebleeding after aSAH (Class I; Level of Evidence B). 1、对大部分患者而言，破裂动脉的外科夹闭或血管内栓塞应尽早进行以降低再出血风险（I级推荐，B级证据） 2. Complete obliteration of the aneurysm is recommended whenever possible (Class I; Level of Evidence B). 2、推荐只要条件许可，任何时间都应完全阻塞动脉瘤。（I级推荐，B级证据） 3. Determination of aneurysm treatment, as judged by both experienced cerebrovascular surgeons and endovascular specialists, should be a multidisciplinary decision based on characteristics of the patient and the aneurysm (Class I;