Citerio G, Galli D, Cadore B, Rondelli E, Sala F, Abbruzzese C
Division of Neurology and Intensive Care, Department of Perioperative Medicine and Intensive Care, AO San Gerardo of Monza, Milan, Italy.
Minerva Anestesiol. 2006 Jun;72(6):407-12.
In the last 15 years new therapeutic approaches have influenced the treatment of ischemic stroke victims. Aim of this review is to point out the elements of a modern approach to the acute stroke patient. The likelihood of saving ischemic cerebral tissue is time-dependent and the treatment goal is to minimise brain damage. The NINDS trial has documented a higher likelihood of better outcome if the fibrinolytic therapy is administered within 3 h of onset of symptoms. To reach this target several interventions are necessary. First of all, education is needed to diffuse public awareness of stroke warning signs. Moreover, out-of-hospital treatment should be optimised with rapid triage and transport to an hospital with a comprehensive stroke approach. The early hospital phase should comprehend a rapid evaluation and an urgent CT scan. After the verification of the inclusion/exclusion criteria, in a authorised SITS-MOST centre, the patient should receive fibrinolytic therapy. The diagnostic and the therapeutic phase should include rapid identification and treatment of secondary insults, as hyperthermia and hyperglycaemia, that have a negative influence on outcome. Despite advances in diagnosis and monitoring, fibrinolytic therapy is the only treatment with a proven efficacy in achieving a higher functional outcome. The narrow time-window is the reason for the need of rapid and well-organised out-of-hospital and in-hospital systems.
在过去15年中，新的治疗方法对缺血性中风患者的治疗产生了影响。本综述的目的是指出急性中风患者现代治疗方法的要素。挽救缺血性脑组织的可能性取决于时间，治疗目标是将脑损伤降至最低。美国国立神经疾病与中风研究所（NINDS）的试验表明，如果在症状发作后3小时内进行纤维蛋白溶解疗法，获得更好预后的可能性更高。为了实现这一目标，需要采取多种干预措施。首先，需要开展教育以提高公众对中风警示信号的认识。此外，应通过快速分诊并转运至具备全面中风治疗方法的医院来优化院外治疗。医院早期阶段应包括快速评估和紧急CT扫描。在核实纳入/排除标准后，在经授权的中风国际登记处-多中心随机对照试验（SITS-MOST）中心，患者应接受纤维蛋白溶解疗法。诊断和治疗阶段应包括快速识别和治疗对预后有负面影响的继发性损伤，如体温过高和血糖过高。尽管在诊断和监测方面取得了进展，但纤维蛋白溶解疗法是唯一经证实对实现更高功能预后有效的治疗方法。狭窄的时间窗是需要快速且组织完善的院外和院内系统的原因。
