卒中急诊救治环节的优化-课件.pptVIP

* 脑出血 时间窗的概念尚有争议，国内目前习惯： 超早期为：3～6h； 急性期为2～7 d； 亚急性期为8～30 d。 * 超超早期手术（3h内）——解除了血肿占位效应，减轻脑水肿和细胞毒性脑损害，神经功能损害轻，脑机能恢复好。但再出血和死亡率明显高。 超早期手术（5-7h）——血肿形成已较致密，血肿周围脑组织开始出现水肿、变性，炎性细胞侵入，此时若及时清除血肿可使部分神经细胞水肿减轻而得以挽救。因此疗效好、死亡率低的特点。 早期组（7-24h）——早期疗效较好，死亡率较低，由于神经元受压时间长，变性、坏死严重，脑机能恢复差，出院6m随访生活质量低于超早期组。 脑出血去骨瓣减压术治疗 * 微创颅内血肿抽吸引流术暨血肿碎吸术 精品课件资料 Stroke Treatment Year 2000 and Beyond This slide summarises the hopes and aspirations we should have for our acute stroke patients in the next century. The aim should be that education of the public and emergency services will ensure the arrival of help for most patients within 15 minutes of stroke onset. At some time in the future, it may become possible to begin the infusion of effective neuroprotection while the patient is in transit to hospital. On arrival at the hospital, the stroke patient will receive top priority from the emergency room or other receiving centre, and a brain scan will confirm the diagnosis within 60 minutes of stroke onset. This will enable clot-dissolving and neuroprotective drugs to be administered together in a ‘stroke-treatment’ cocktail well within the 3-hour therapeutic window, thereby, we hope, allowing a full recovery in a far greater percentage of patients than at present. It is currently anticipated that the therapeutic window for these interventions will be found to be longer than 3 hours – probably around 6–8 hours. Although the earliest possible treatment will still be preferable, patients may still obtain benefit from treatments given later in the therapeutic window. In recovering stroke patients, standardised follow-up will be mandatory and will include the implementation of rehabilitation and secondary prevention measures, including the use of antiplatelet drugs. 47 颈内动脉、大脑中动脉 均大于30ml，无脑疝形成，呼吸、循环功能稳定。 后向血肿腔注尿激酶溶液2 ml溶解血肿固态部分，夹闭4 h，开放引流。术后每天冲洗血肿腔2～3次，动态复查头颅cT，血肿清除80％以上即拔针。 * 延时文字 卒中急诊救治环节的优化 * “时间就是大脑” 卒中就是急症 缺血性卒中 出血性卒中 精品资料 你怎么称呼老师？ 如果老师最后没有总结一节课的重点的难点，你是否会认为老师的教学方法需要改进？ 你所经历的课堂，是讲座式还是讨论式？ 教