Wiersma T J, Pleumeekers H J C M, Beusmans G H M I, Schuling J, Goudswaard A N
Nederlands Huisartsen Genootschap, afd. Richtlijnontwikkeling en Beleid, Postbus 3231, 3502 GE Utrecht.
Ned Tijdschr Geneeskd. 2005 Dec 17;149(51):2850-6.
The practice guideline 'CVA' from the Dutch College of General Practitioners provides guidelines for the management of stroke patients. The guideline is in agreement with the changing insights about the benefits of stroke-units and thrombolysis. The most important recommendations are the following. In the acute phase, most patients with a cerebrovascular accident should be referred for admission to a stroke-unit. Exceptions are patients with only slight neurological disability and patients with severe comorbidity. Patients with a CVA that started less than three hours ago should be referred for emergency thrombolytic therapy in regions where this possibility exists. In situations in which the general practitioner considers a home visit to involve an unacceptable loss of time, he may decide to refer on the basis of the results of the 'face-arm-speech-time' (FAST) test, which can be administered by telephone. For patients that remain at home, the general practitioner sees to the early start of a rehabilitation programme, and takes the initiative if necessary. The general practitioner can support stroke patients with permanent neurological deficits by considering them to be chronically ill patients requiring regular check-ups.
荷兰全科医生学院的“CVA（短暂性脑缺血发作）”实践指南为中风患者的管理提供了指导方针。该指南与对中风单元和溶栓治疗益处的不断变化的见解相一致。最重要的建议如下。在急性期，大多数脑血管意外患者应被转诊至中风单元住院治疗。例外情况是仅有轻微神经功能障碍的患者和患有严重合并症的患者。在有条件进行紧急溶栓治疗的地区，发病时间少于三小时的短暂性脑缺血发作患者应被转诊接受紧急溶栓治疗。在全科医生认为家访会导致不可接受的时间损失的情况下，他可以根据通过电话进行的“脸-臂-语言-时间”（FAST）测试结果决定转诊。对于留在家中的患者，全科医生负责尽早启动康复计划，并在必要时采取主动措施。全科医生可以将患有永久性神经功能缺损的中风患者视为需要定期检查的慢性病患者，从而为他们提供支持。
