Chang Yeu-Jhy, Ryu Shan-Jin, Chen Jiunn-Rong, Hu Han-Hwa, Yip Ping-Keung, Chiu Te-Fa
Department of Neurology and Stroke Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.
Acta Neurol Taiwan. 2008 Dec;17(4):275-94.
The content of the second edition of "Guideline for General Management of Patients with Acute Ischemic Stroke" was amended from the first edition of that of the Taiwan Stroke Society in 2002. The format of the guideline followed the common unified instruction for the project of "The establishment of clinical guidelines for the top 10 payments diseases of the National Health Insurance at the departments of inpatients, emergency and outpatients" as recommended by the National Health Research Institutes (NHRI). The guideline was revised after several official meetings of local experts, as well as citation from the latest updated guidelines of the United States and the European Stroke academic groups. Before editing notice, the final evaluation was performed by the review team of the NHRI. Application of the guideline is dedicated or designated to the patients with acute ischemic stroke, and which is applied only limited to the general management. Guidelines for subacute or chronic phase, or the specific treatment for ischemic stroke patients will be published in separated articles. Management of most of the needs for patients with acute ischemic stroke must be completed in a very short period of time. It is recommended that hospitals providing stroke service to set up stroke unit, and to organize an integrated stroke team consisting of specialists from multiple disciplines. Upon arrival to the hospitals, patients should undergo the brain computed tomography, and related examinations and assessment as soon as possible to guide the choice of treatment reference for acute intervention. Intravenous recombinant tissue plasminogen activator treatment within three hours is effective in reducing disability for patients with acute ischemic stroke. Ischemic stroke patients with or without persistent symptoms should start antiplatelet therapy immediately, generally aspirin. Dose-adjusted warfarin (INR range of 2.0-3.0) is recommended for ischemic stroke patients with persistent or paroxysmal atrial fibrillation to prevent secondary embolism. The routine use ofheparin and drugs theoretically preventing further brain injury, including steroids, neuroprotectants, plasma volume expanders, barbiturates, and streptokinase, has not been proven benefits for recommendation.
《急性缺血性中风患者综合管理指南》第二版内容修订自台湾中风学会2002年的第一版指南。该指南的格式遵循了国立卫生研究院（NHRI）推荐的“国民健康保险住院、急诊和门诊部门十大支付疾病临床指南制定项目”的通用统一指导原则。该指南经过当地专家多次正式会议修订，并参考了美国和欧洲中风学术团体最新更新的指南。在编辑通知之前，由NHRI的审查团队进行了最终评估。本指南专门适用于急性缺血性中风患者，且仅适用于综合管理。亚急性或慢性期指南，或缺血性中风患者的具体治疗方法将另行发表。急性缺血性中风患者的大多数需求管理必须在很短的时间内完成。建议提供中风服务的医院设立中风单元，并组建由多学科专家组成的综合中风团队。患者入院后，应尽快进行脑部计算机断层扫描及相关检查和评估，以指导急性干预治疗参考的选择。急性缺血性中风患者在三小时内静脉注射重组组织型纤溶酶原激活剂治疗可有效降低残疾率。有或无持续症状的缺血性中风患者应立即开始抗血小板治疗，一般使用阿司匹林。对于有持续性或阵发性心房颤动的缺血性中风患者，建议使用剂量调整的华法林（国际标准化比值范围为2.0 - 3.0）以预防继发性栓塞。肝素及理论上可预防进一步脑损伤的药物，包括类固醇、神经保护剂、血浆扩容剂、巴比妥类药物和链激酶的常规使用，尚未被证实有推荐使用的益处。
