规范抗栓,全程保护-缺血性脑卒中二级预防抗血小板治疗的优化管理（美化）.pptVIP

最佳剂型—精确肠溶的拜阿司匹灵 拜阿司匹灵：精确肠溶，不伤肠胃 溶解位置－小肠 与普通阿司匹林相比，胃肠道 不良反应减少 60% 中国临床药学杂志，2001年第10卷第5期 缺血性卒中二级预防仅有指南是完全不够 卒中可防不可测 二级预防可减少卒中发生 卒中预防靠规范而非新技术 NCEP,national Cholesterol Education Program. Pearson TA,et al. Arch Intern Med. 2000;160:459-467 样本（%） 如何用项目推动指南到实践的规范化管理?借鉴美国指南推广项目(From 2001 to Now) Get With The Guidelines–Stroke (GWTG–Stroke) helps ensure continuous quality improvement of acute stroke treatment and ischemic stroke prevention. It focuses on care team protocols to ensure that patients are treated and discharged appropriately. The program is available for?implementation?at acute care hospitals nationwide. GWTG–Stroke identifies hospital staff (champions) to lead, develop and mobilize teams to implement treatment and discharge?guidelines?for patients in acute care hospitals. The guidelines-based treatment is consistently measured and evaluated using an exclusive and customized Web-based tool called the?Patient Management ToolTM* (PMT). 小 结 * REACH 研究: 超过68,000名患者，来自全球44个国家的5,473个中心*中国入组的病人共710例，来自69个中心（包括心血管和神经内科） 中国的研究牵头者为：高润林教授和吕传真教授 REACH研究的基线数据（病人特征、治疗情况等）已发表在JAMA 2006;295(2):180-9 * 于只有一个动脉血管床病变的患者相比，有多个血管床病变的患者的严重心血管事件的发生率较前者升高1倍。 * * 每7名卒中患者即有1名1年内再发重大血管事件（卒中、心梗等） 糖尿病是卒中后再发的最强参考因素 卒中再发风险为心梗和心血管死亡之和 有多重风险因素者再发风险高，二者呈正相关 多血管床病变患者血管事件再发风险是单血管床病变的2倍以上 2/5 脑血管病患者同时有其他部位血管病变 This slide shows the rate of major cardiovascular events at one year (percentage of population). Rates are 2?3 times higher in the symptomatic subgroup compared with the ≥3 risk factors only subgroup.1 Atherothrombotic events include: transient ischemic attack unstable angina other ischemic arterial events including worsening of peripheral arterial disease.1 *For the combined endpoint, if a patient experienced hospitalization as a result of TIA and subsequently died, he/she will be counted once. But if a patient died with a MI death cause, he/she would be counted once for the outcome MI and once for the outcome CV death. －所有REACH患者1年中有3.5％的患者发生心血管死亡/心梗/ 卒中。如果加上因AT原因（ TIA, 不稳定型心绞痛、