解读美国2013《急性缺血性卒中的早期治疗指南》.pptVIP

临床未证实有效的脑保护治疗 钙通道阻滞剂 Nimodipine ，尼莫地平 flunarizine, 氟桂利嗪 NMDA受体拮抗剂 aptiganel，阿替加奈 YM-90K, GABA 增效剂 clomethiazole, 氯美噻唑 甘氨酸拮抗剂 gavestinel 谷氨酸拮抗剂 selfotel,赛福太 Lubeluzole，芦贝鲁唑 防止细胞外谷氨酸增加，阻断激活的NO通路 Citicoline 神经营养因子 神经节苷脂 目前临床试验有效的脑保护治疗 镁 盐 脂质过氧化抑止剂 抗自由基 Tirilazad mesylate，甲磺酸替拉扎特 ※ Enlimomab，恩莫单抗 ▲ 非药物性 亚低温 Stroke is caused by a transient or permanent interruption of blood flow that leads to ischemia and triggers a complex series of pathophysiological events that cause injury to the brain1. The consequences of these cerebrovascular events for the patient may be death, or disability with loss of productivity and a decrease in quality of life. The lack of effective acute stroke treatment is a major health burden for patients, their families, and society in general2. References 1. Dirnagl U, Iadecola C, Moskowitz MA. Pathobiology of ischaemic stroke: an integrated view. Trends Neurosci 1999; 22: 391-397. 2. Feuerstein GZ, Peters EE, Wang X. Inflammation and Stroke: benefits or harm? In Progress in Inflammation Research. Parnham MJ, ed. Basel, Switzerland: Birkh?user Verlag AG; 2001: 213-225. Massachusetts General Hospital acute stroke imaging algorithm for triage of patients with severe ischemic strokes caused by anterior circulation occlusions. All patients undergo non-contrast CT (NCCT) followed by CT angiography (CTA). If the patient has severe neurological deficits (National Institutes of Health Stroke Scale score ≥10), no large hypodensity and no hemorrhage on NCCT, and an occlusion is identified of the distal internal carotid artery and/or proximal middle cerebral artery that is accessible by microcatheter, then the patient is immediately evaluated by diffusion MRI if there are no contraindications to MRI. If the diffusion weighted imaging (DWI) lesion is small, defined as 70?ml, then the patient is immediately triaged to endovascular therapy if the patient is otherwise eligible for such treatment. If the patient is not eligible for MRI, he/she may un