Ingall T J
Mayo Medical School, Rochester, Minnesota, USA.
Postgrad Med. 2000 May 15;107(6):34-6, 39-42, 47-50. doi: 10.3810/pgm.2000.5.15.1087.
Preventing stroke is the most important strategy for reducing the cost of this disease. Management of modifiable risk factors, especially hypertension and Oral anticoagulation with warfarin for selected high-risk patients with nonvalvular atrial fibrillation. Carotid endarterectomy for selected patients with carotid artery stenosis greater than 60%. Regular physical exercise. Treatment with statin medications for patients who have coronary artery disease with or without hyperlipidemia. Routine use of antiplatelet medication has no proven role in primary stroke prevention, although aspirin is often prescribed for patients with vascular risk factors who have not yet had symptoms of either stroke or ischemic heart disease. The major strategies for secondary stroke prevention are: Appropriate evaluation to identify the mechanism of the initial stroke. Carotid endarterectomy for patients with symptomatic carotid artery stenosis of 50% or more. Oral anticoagulation with warfarin for patients with nonvalvular atrial fibrillation. Use of various antiplatelet agents, including aspirin, ticlopidine, clopidogrel, and the combination of aspirin and slow-release dipyridamole. Whether treatment of risk factors reduces the risk of secondary stroke is currently being evaluated in clinical trials.
预防中风是降低这种疾病成本的最重要策略。管理可改变的风险因素，特别是高血压，并对选定的非瓣膜性心房颤动高危患者使用华法林进行口服抗凝治疗。对选定的颈动脉狭窄大于60%的患者进行颈动脉内膜切除术。定期进行体育锻炼。对患有或未患有高脂血症的冠心病患者使用他汀类药物治疗。常规使用抗血小板药物在一级预防中风中尚未证实有作用，尽管阿司匹林常被开给有血管危险因素但尚未出现中风或缺血性心脏病症状的患者。二级预防中风的主要策略包括：进行适当评估以确定初始中风的机制。对有症状的颈动脉狭窄50%或以上的患者进行颈动脉内膜切除术。对非瓣膜性心房颤动患者使用华法林进行口服抗凝治疗。使用各种抗血小板药物，包括阿司匹林、噻氯匹定、氯吡格雷以及阿司匹林与缓释双嘧达莫的组合。目前正在临床试验中评估对风险因素的治疗是否能降低二级中风的风险。
