Gilman Sid
Department of Neurology, The University of Michigan, 300 North Ingalls Street 3D15, Ann Arbor, MI 48105-0495, USA.
Exp Neurol. 2006 May;199(1):28-36. doi: 10.1016/j.expneurol.2006.03.002. Epub 2006 Apr 24.
Pharmacologic management of the acute phase of the ischemic stroke includes treating the physical and medical conditions that can worsen cerebral injury; administering intravenous thrombolytic therapy (recombinant tissue plasminogen activator) in those who meet current guidelines; instituting prophylactic measures to prevent medical complications; and initiating passive rehabilitation measures. New approaches under investigation include intra-arterial thrombolytic therapy; endovascular embolectomy and clot disruption; and neuroprotective treatments to preserve surviving ischemic tissue. One neuroprotective agent given within 6 h after stroke onset, NXY059, recently met the primary outcome measure in a phase III clinical trial. Pharmacologic management of the subacute and chronic phases involves treatment of risk factors for recurrent stroke and other forms of cardiovascular disease, including hypercholesterolemia, hypertension, and diabetes mellitus. In this phase, antiplatelet therapy can be initiated or continued; smoking, obesity and alcohol intake can be managed; and active rehabilitation can begin through physical, occupational, and speech therapy. A few medications to augment rehabilitation have shown promising results in small clinical trials, but none have been tested in large phase III trials or approved by the US or European regulatory agencies. Thus, there are no pharmacologic measures available to enhance central nervous system restorative processes after acute stroke, and implantation of stem cells provides one promising approach, not only for cell replacement but also for the provision of therapeutic molecules.
缺血性中风急性期的药物治疗包括治疗可能加重脑损伤的身体和医学状况；对符合现行指南的患者给予静脉溶栓治疗（重组组织型纤溶酶原激活剂）；采取预防措施以防止医学并发症；以及启动被动康复措施。正在研究的新方法包括动脉内溶栓治疗；血管内取栓和血栓破碎；以及保护存活缺血组织的神经保护治疗。一种在中风发作后6小时内给予的神经保护剂NXY059，最近在一项III期临床试验中达到了主要结局指标。亚急性期和慢性期的药物治疗包括治疗复发性中风和其他形式心血管疾病的危险因素，包括高胆固醇血症、高血压和糖尿病。在这个阶段，可以开始或继续抗血小板治疗；可以控制吸烟、肥胖和饮酒；并且可以通过物理、职业和言语治疗开始积极康复。一些增强康复效果的药物在小型临床试验中显示出有希望的结果，但没有一种在大型III期试验中进行过测试，也未获得美国或欧洲监管机构的批准。因此，在急性中风后没有可用的药物措施来增强中枢神经系统的修复过程，而干细胞植入提供了一种有希望的方法，不仅用于细胞替代，还用于提供治疗分子。
