急性脑卒中急诊救治指南.ppt

* 20 EMS Response: Preparation for Transfer (1) This slide highlights a number of very important measures that should always be implemented before embarking on patient transportation. Brief documentation of the onset of the stroke symptoms should be made whenever possible, since this may yield useful diagnostic information. The patient is frequently unable to speak, and is usually confused and distressed, – in view of this it is useful to talk to family members or other onlookers who may have witnessed the attack. * EMS Response: Preparation for Transfer (2) This slide serves as a reminder of the important ‘do nots’ in the prehospital management of stroke. The first of these is that it is very important not to be complacent in cases in whom impairments are mild or are rapidly regressing, as this may be an indication that the patient’s situation is an unstable one in which rapid intervention may prevent irreversible damage. Another very important point is that sedation is only necessary if the patient is agitated; otherwise, it always has the effect of making diagnostic evaluation more difficult, and may be extremely hazardous in some cases. 21 脑出血研究的进展 ★脑出血脱水治疗的认识：①出血停止后才开始脱水(不是越早越好) a.降颅压解除了对出血的压迫； b.短期血容量增加可促进出血。②甘露醇应用： a.不宜过强，每次20%~125ml与250ml脱水效果相当。 b.不宜过长，不宜＞5天，有人建议＜9次)。MRI证实过长不但不脱水，反而潴留于细胞间隙，加重脑水肿。 2007年成人自发性脑内出血治疗指南 AHA建议中采用的证据分类和水平 分类 Ⅰ类 有证据表明和（或）普遍认同支持该措施或治疗有用、有效 Ⅱ类 关于该措施或治疗的有用性/有效性存在着证据冲突和（或）意见分歧 Ⅱa 类 大多数证据或意见支持该措施或治疗 Ⅱb 类 有用性/有效性未能得到证据或意见的充分证实 Ⅲ类 有证据表明和（或）普遍认同认为该措施或治疗无用/无效，而且某些情况下甚至可能有害 治疗建议的证据水平 A 资料来自于多个随机临床试验 B 资料来自于单个随机试验或非随机研究 C 专家共识 诊断建议的证据水平 A 资料来自于多个采用参考标准进行盲法评价的前瞻性队列研究 B 资料来自于一个单独的A级研究或者一个或多个病例对照研究或者采用参考标准未进行盲法评价的的研究 C 专家共识 2007年成人自发性脑内出血治疗指南 急诊诊断和评价脑内出血的建议 Ⅰ类 （1）脑内出血是急症，经常有早期持续出血和进行性恶化，严重的临床功能缺损，导致高死亡率和患病率，应及时识别和确诊（证据水平A）。 （2）CT和MRI都是初步影像学检查的首选（Ⅰ类，证据水平A）；如果患者有MRI检查的禁忌，应当查CT（证据水平A）。 2007年成人自发性脑内出血治疗指南 自发性脑内出血血压升高时的治疗建议 （1）如果收缩压＞200 mmHg或平均动脉压＞150 mmHg，要考虑用持续静