Dhamija Rajinder K, Donnan Geoffrey A
National Stroke Research Institute, Austin Health, University of Melbourne, Victoria.
Aust Fam Physician. 2007 Nov;36(11):892-5.
In recent years, four specific strategies have emerged which have proven clinical benefit in treating acute stroke. These are the administration of tissue plasminogen activator (tPA), aspirin, management in a stroke care unit (SCU) and the use of hemicraniectomy in patients with severe cerebral oedema.
This article discusses current management strategies and evidence with emphasis on the role of the general practitioner in initial diagnosis and hospitalisation.
Although tPA has been shown to be remarkably clinically effective, less than 5% of eligible stroke patients receive this therapy. The main obstacle is its very narrow therapeutic time window of 3 hours. This necessitates the immediate recognition of stroke and rapid transfer to hospital. Computerised tomography is mandatory to rule out cerebral haemorrhage. Starting aspirin within 48 hours of stroke onset in patients with ischaemic stroke results in a significant reduction in mortality and morbidity. Management in a SCU is the most useful intervention with significant reductions in mortality and morbidity for all stroke subtypes. The management of stroke is changing, and the role of the GP is crucial in facilitating the rapid transfer of patients to a SCU together with subsequent risk factor control and community support.
近年来，已出现四种在治疗急性卒中方面被证明具有临床益处的特定策略。这些策略包括组织型纤溶酶原激活剂（tPA）的应用、阿司匹林的使用、在卒中监护病房（SCU）进行管理以及对重度脑水肿患者实施去骨瓣减压术。
本文讨论当前的管理策略和证据，重点关注全科医生在初始诊断和住院治疗中的作用。
尽管tPA已被证明具有显著的临床疗效，但 eligible 卒中患者中接受该治疗的不到5%。主要障碍是其非常狭窄的3小时治疗时间窗。这就需要立即识别卒中并迅速转诊至医院。必须进行计算机断层扫描以排除脑出血。对于缺血性卒中患者，在卒中发作48小时内开始使用阿司匹林可显著降低死亡率和发病率。在SCU进行管理是最有效的干预措施，可显著降低所有卒中亚型的死亡率和发病率。卒中的管理正在发生变化，全科医生的作用对于促进患者迅速转诊至SCU以及随后的危险因素控制和社区支持至关重要。
