急性脑血管意外.ppt

* * * * * * * * * * * 单纯跌倒发作并不是PCI的常见表现。 ???? 后循环缺血的评估和诊断 详细的病史、体格检查和神经系统检查是诊断的基础。 对以头晕/眩晕为主诉者，一定要进行Dix-Hallpike检查。 The Dix-Hallpike Test PCI几个重要认识（小结） 1． PCI包括后循环的TIA（即经典的VBI）和脑梗死。 2．PCI的主要病因与前循环缺血相同，颈椎病不是PCI的主要病因。 3．头晕/眩晕是PCI的常见表现，多伴有其他表现，单纯的头晕/眩晕极少是PCI。 4．转颈或体位变化后的头晕/眩晕的主要病因不是PCI。 5．对PCI的诊断检查、治疗和预防应与前循环缺血一致。 预防优于治疗 腹型肥胖：心脑血管病危险 因素 （每天少一口，体重向下走） 1 运动 谢谢 * * 脑梗死急性期死亡率很高，卒中发作后7天的死亡率是12％，1个月的死亡率高达19％ Case fatality is generally accepted to be 12% within the first seven days and 19% at one month for first-ever stroke. Patients with primary or subarachnoid cerebral haemorrhage and those with total anterior circulation infarcts are at highest risk of death. Some patients die within hours as a result of the ischaemic insult or cardiac complications, others succumb at between five and 10 days to the effects of cerebral oedema. Late deaths are usually due to the consequences of immobilisation and early or delayed stroke recurrence, especially in patients with subarachnoid haemorrhage, in whom the risk of death from re-bleeding is as high as 30%. Patients with brain stem involvement, caused either by the primary ischaemic process or by compression due to raised intracranial pressure, are at high risk of death. The risk of death falls after the first 30 days to about 9% per annum, twice that for the population atlarge. 卒中首次发作后30天的卒中复发率是2－3％，6个月的复发率是9％，1年的复发率是10－16％。是普通人群的9倍，是同年龄和性别人群的15倍 Stroke recurrence has been divided, on the basis of recent clinical trials, into early (within two weeks) and delayed (often beyond three months) recurrence. Regardless of cause, the risk of stroke recurrence is highest early after first-ever stroke and delay minimises the benefit of any intervention. About 2–3% of patients have recurrent stroke within the first 30 days afterstroke, 9% in the first six months and 10–16% in the first year. That is, stroke patients have a risk 15 times that of an age- and sex-matched population. Thereafter the risk becomes lower and is about nine t