Reza Noorian A, Nogueira R, Gupta R
Department of Neurology, Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA.
J Neurosurg Sci. 2011 Jun;55(2):127-38.
Acute ischemic stroke, one of the most prominent causes of death and disability in the modern world has attracted an extensive amount of research on its pathophysiology and treatment. There has been significant progress with successful reperfusion treatments associated with improved clinical outcomes, but neuroprotective strategies have failed to show clinical benefit despite promising benchtop results. Unfortunately reperfusion strategies can be employed in a small number of patients who present in the appropriate time window. Neuroprotective strategies may aid in prolonging time windows, thereby potentially increasing the number of eligible patients to benefit from reperfusion treatments. Additional strategies can be used to potentially protect the brain after reperfusion thereby preventing edema and hemorrhage. Previous clinical studies have failed to show benefit likely due to poor patient selection, altering time windows that had shown benefit in bench models and failure to link treatments with reperfusion.
急性缺血性中风是现代世界中导致死亡和残疾的最主要原因之一，其病理生理学和治疗方法已吸引了大量研究。成功的再灌注治疗取得了显著进展，临床结果有所改善，但尽管在实验室研究结果令人鼓舞，神经保护策略却未能显示出临床益处。遗憾的是，再灌注策略仅适用于少数在适当时间窗内就诊的患者。神经保护策略可能有助于延长时间窗，从而有可能增加 eligible patients（这里原文有误，应是“符合条件的患者”）从再灌注治疗中获益的人数。还可采用其他策略在再灌注后潜在地保护大脑，从而预防水肿和出血。以往的临床研究未能显示出益处，可能是由于患者选择不当、改变了在实验模型中已显示有益的时间窗以及未能将治疗与再灌注联系起来。
