急性缺血性中风的处理新发展及其争议-SAGEJournals.pdfVIP

Hong Kong Journal of Emergency Medicine Acute ischaemic stroke: management, recent advances and controversies 急性缺血性中風的處理，新發展及其爭議 GCK Wong 黃志強 and CH Chung 鍾展鴻 Acute ischaemic stroke is a major cause of death and disability. It may become an enormous burden to the patients themselves, their families as well as the health care systems. Patients at risk of airway, breathing and circulatory compromise should receive prompt resuscitation. Vital parameters and neurological status should be closely monitored. Attentions to blood pressure, temperature and sugar profile are important. The significance of early and correct diagnosis and subsequent treatment cannot be over-emphasised. There have been tremendous recent advances in different treatment modalities in acute stroke management. Various recanalisation modalities include intravenous and/or intra-arterial thrombolysis, acute defibrinogenation, anti-platelet treatment and anticoagulation. Carotid endarterectomy and endovascular strategies are recommended in selected patients. Advanced neuro-imaging techniques and neuroprotectants are being evaluated. Multidisciplinary stroke teams have been shown to improve patient survival and functional outcome. Pre-defined algorithms and protocols should be in place to expedite smooth and effective delivery of stroke service. Future directions should be aimed at exploring safer recanalisation modalities and extending the limit of the current 3-hour treatment window for thrombolysis. (Hong Kong j.emerg.med. 2004;11:35- 52) 急性缺血性中風是死亡及傷殘主要原因之一，並對病者、家人及醫療衛生系統構成沈重的負擔。對於氣 道、呼吸及循環系統有存在危險的病者應迅速搶救，並應緊密監察維生指標及神經狀況；特別是血壓、 體溫及血糖的概況至為重要。早期正確的診斷及隨後的治療尤應強調。近年有關急性中風的處理，在不 同的治療模式上有重大的進展。多種的管道再通技術包括靜脈或/和動脈內的血栓溶解、急性去纖維蛋 白元、抗血小板及抗凝血療法等；對於個別選擇性的病者更有建議進行頸動脈內膜切除術及血管內的策 略性治療。先進的神經顯影技術及神經保護劑的使用亦在被評估中。有顯示由多個學科組成的中風醫療 隊伍攜手合作能有效改善病者生存率及功能的回復。醫療系