神经保护剂在缺血性脑卒中的应用现状.docVIP

神经保护剂在缺血性脑卒中的应用现状 　　[摘要] 脑卒中是威胁人类健康的三大疾病之一，具有高患病率、高复发率、高致残率、高死亡率的特点，目前已经成为我国人口死亡和致残的第一位原因，急性缺血性脑卒中（急性脑梗死）是最常见的卒中类型。神经保护剂可减小脑梗死面积，无溶栓、抗凝治疗出血的并发症，没有严格的时间限制等优势，使得早期治疗成为可能，但治疗的疗效没有得到很好的循证医学证据支持。本文探讨了各国神经保护剂的指南推荐情况与我国生产应用现状及医保报销情况，发现绝大多数神经保护剂在各国都未做推荐，但我国存在广泛应用的现象，期望此文给临床医生合理使用神经保护剂和医保政策的制订提供参考。 　　[关键词] 缺血性脑卒中；神经保护剂；指南推荐；合理应用；医保政策 　　[中图分类号] R742 [文献标识码] A [文章编号] 1673-7210（2016）09（c）-0067-04 　　[Abstract] Stroke is one of the three major diseases that threat human health. The diseases were with high prevalence， high recurrence rate and high morbidity and mortality rate. It was reported that stroke had become the top one reason of death and disability in China. Acute ischemic stroke （acute cerebral infarction） is the most common type of stroke. The nerve protective medications can reduce cerebellar infarction areas and without side effects such as bleeding complications caused by anticoagulation. Meantime， there were no strict time limit and other disadvantages during the treatment. This article consults the neural protection guidelines and system review the recommended situations and application in the treatment of stroke. And it is also reviewed the medications usage in our country. According to our research， it is found that the nerve protection agents in our countries do not make recommendations， but there were wide spread applications in our country. Through this article， it is hoped to provide a reference for clinical doctor to rational use of nerve protective agent， and supply evidence for the establishment of medical insurance policy. 　　[Key words] Ischemic stroke； Neuroprotective agents； Guideline recommend； Rational drug use； Policy of medical insurance 　　在过去的十年中，卒中是世界范围内第二位导致死亡和引发长期且严重的神经系统疾病的原因[1]，到2020年卒中治疗费用将达到所有疾病负担的6.2%。最新发布的《中国急性缺血性脑卒中诊治指南2014》明确指出，急性缺血性脑卒中特异性治疗的主要手段为：第一，改善脑血循环，进行血管再通，迅速复流以挽救缺血半暗带；第二，神经保护，减少再灌注损伤、抑制缺血级联反应以减轻神经功能缺损。近20多年来国际上进行了多种神经保护剂研究，基础研究和动物实验结果十分令人鼓舞，但临床试验尚未取得满意结果，截至目前为止尚没有一个公认的、被指南所推荐的药物，神经保护剂的疗效与安全性尚需开展更多高质量临床试验进一步证实（我国I级推荐，B级