急性脑梗死课件.pptxVIP

急性脑梗死 第一节 急性脑梗死的概述是由于局部脑血流中断引起,时间超过2小时,DWI上有表现。占脑卒中的85%。85% 预后是好的,15%的缺血脑卒中预后差,死亡率高。 第二节 急性脑梗死的病因脑动脉粥样硬化:高血压、高血脂、吸烟小血管玻璃样变:高血压、糖尿病低灌注性脑梗死:动脉狭窄心源性脑栓塞:冠心病、风心病血管炎:SLE、 结核、螺旋体动脉炎其它:避孕药。 第三节 急性脑梗死的分类OCSP:按临床症状分:完全前循环、部分前循环、完全后循环、腔隙性脑梗死 ASCO:A-动脉硬化,S-小血管,C-心源性,O-其它 第四节 急性脑梗死的诊断血脂、糖代谢、HCY心脏、血管彩超头颅CT及CT A头颅MRI及MRADSA OCSP完全前循环:意识障碍、眼球注视、语言障碍加偏瘫(皮层枝加深穿支)部分前循环:皮层枝或深穿支完全后循环:四肢瘫痪、眩晕、意识障碍腔隙性脑梗死:21型,常见有5型。 急性脑梗死的治疗 脑梗死的急性期治疗超早期溶栓治疗抗栓治疗他汀类药物抗高血压药物控制高血糖抗炎神经保护剂脱水问题 超早期溶栓治疗 抗栓治疗The annualized rates of total Major bleeding events Secondary stroke prevention of antithromboticsAm J Cardiol、 2009,15;103(8):1107-12、 Design13 studies follow-up: or =1 year to pare:aspirin ( or =325 mg/day), clopidogrel, anticoagulants (warfarin and other vitamin K antagonists), aspirin plus clopidogrel, and aspirin plus extended-release dipyridamole (ER-DP) Total bleeding rate4、8%-aspirin ( or =325 mg/day) 2、9% - clopidogrel3、6%- aspirin plus ER-DP10、1% - aspirin plus clopidogrel16、8%- anticoagulation Major bleeding rate1% - aspirin ( or =325 mg/day) 0、85%-clopidogrel0、93%-aspirin plus ER-DP1、7%-aspirin plus clopidogrel2、5%-anticoagulation ConclusionThe bination of aspirin and clopidogrel is associated with significantly greater bleeding than either aspirin ( or =325 mg/day) or clopidogrel alone、 Aspirin plus ER-DP has a greater bleeding rate than clopidogrel but a lower rate than aspirin ( or =325 mg/day) alone Proton-pump inhibitors (PPIs) and clopidogrel 13,608 patients 33% (n=4529) of patients were on a PPI at randomisation No association existed between PPI use and risk of the primary endpointThe current findings do not support the need to avoid conitant use of PPIs Lancet、 2009 Sep 19;374(9694):989-97、 Epub 2009 Aug 31 Statins for strokePleiotropic effectsPrevent OR treatment ?critically ill patients?肾病血透病人及肾移植病人?出血性卒中?大剂量与标准剂量? pleiotropic effects of statins pleiotropic effects beyond their effects on cholesterol levels vasoprotective mechanismsimproved endothelial func