Sebastian Schulz-Stübner, MD BZH Freiburg, Stühlinger Straße 21, 79106 Freiburg im Breisgau, Germany.
Curr Treat Options Neurol. 2007 Nov;9(6):427-41. doi: 10.1007/s11940-007-0044-z.
Patients admitted with the diagnosis of "stroke" have a variety of different disorders that require specific treatment approaches in the critical care unit. Early thrombolysis for ischemic stroke and improvements in surgical and neurointerventional techniques for the treatment of aneurysms and arteriovenous malformations in patients with subarachnoid hemorrhage have been milestones in the past decade, but the evolvement of general management principles in critical care and the dedication of neurointensivists are equally important for improved outcomes. Strategies, which have been developed in other areas of intensive care medicine (eg, in patients with septic shock, acute respiratory distress syndrome, or trauma), need to be adopted and modified for the stroke patient. Prevention of iatrogenic complications and nosocomial infections is of utmost importance and requires sufficient numbers of trained personnel and high-quality equipment. Although the focus of attention in stroke patients is "brain resuscitation," comorbidities often limit the diagnostic and therapeutic options, and overall cardiopulmonary and metabolic functions need to be optimized in order to prevent secondary injury and allow the brain to recover. As part of a holistic approach to the rehabilitation process, psychologic and spiritual support for the patient must start early on in the intensive care unit, and family members should be involved in the patient's care and provided with special support as well.
诊断为“中风”的患者在重症监护病房中会有各种不同的病症，需要采用特定的治疗方法。在过去十年中，缺血性中风的早期溶栓治疗以及蛛网膜下腔出血患者的手术和神经介入治疗技术的改进是重要的里程碑，但重症监护中一般治疗原则的发展和神经重症医师的专注同样对改善预后至关重要。在其他重症监护领域（例如，感染性休克、急性呼吸窘迫综合征或创伤患者）制定的策略需要被采用和修改，以适应中风患者。预防医源性并发症和医院感染至关重要，需要足够数量的训练有素的人员和高质量的设备。尽管中风患者的关注焦点是“脑复苏”，但合并症往往会限制诊断和治疗选择，需要优化整体心肺和代谢功能，以防止二次损伤并使大脑得以恢复。作为康复过程整体方法的一部分，必须在重症监护病房早期为患者提供心理和精神支持，并且还应该让家属参与到患者的护理中，并为他们提供特殊支持。
