中风二级预防更新.ppt

Update of secondary stroke prevention Introduction Secondary prevention ： preventing a stroke after a transient ischaemic attack (TIA) or a recurrent stroke after a first stroke. 卒中二级预防概念：在发生TIA或初次中风后预防中风发生或再次发生。 8 to 15% stroke or TIA patients suffer a recurrent stroke in the first year. The recurrence risk is highest in the first few weeks and declines over time. 有8~15%的中风或TIA患者会在第一年内再次中风或发生中风。且风险在最初的几周是最高的，随时间的延长而下降。 So,Immediate evaluation of patients with a stroke or TIA, identification of the pathophysiology and initiation of secondary prevention are of great importance 因此，发生TIA或中风后立即进行评估，了解其病理生理学情况积极启动二级预防措施是非常重要的。 Hypertension 1.HOPE : A meta-analysis comprised seven studies in 15 527 patients with TIA, ischaemic or haemorrhagic stroke. 荟萃分析7项研究涉及15527个TIA、缺血性或出血性中风患者。 Followed up period: 2–5 y. 随访周期：2~5年 Result: (1)Treatment with antihypertensives reduced the risk of stroke by 24%,risk of non-fatal stroke by 21%, risk of myocardial infarction (MI) by 21% and the risk of all vascular events by 21%. 服用控制高血压药物的卒中复发风险降低了24%, 非致死性的卒中风险降低了21%, 心肌梗塞风险降低了21%，所有的血管性事件降低了 21% 。 (2) the combination of an ACEI with a diuretic was more effective (45% risk reduction) than a diuretic as monotherapy (32%),monotherapy with an ACEI(7%) or a beta-blocker (7%). ACEI与利尿剂联用更有效，优于利尿剂、ACEI、β受体阻滞剂各自单用。 2.PROGRESS ： the first large-scale trial specifically performed in patients after stroke. 第一个针对中风后病人实施的大型临床试验。 Method :A total of 6105 patients were treated with perindopril as monotherapy or in combination with indapamide or placebo. 6105例中风后病人或培哚普利单用或与吲哒帕胺、安慰剂联用 Followed up period: 4 y. 随访周期：4年 Result: 1)The absolute risk reduction for recurrent stroke was 4%, and the relative risk reduction (RRR) was 28%. 卒中复发的绝对危险度下降了4%，相对危险度下降了28%. 2)Monotherapy with the ACE inhibitor was not only superior to placebo but also did not achieve the same