Alonso de Leciñana M, Gutiérrez-Fernández M, Romano M, Cantú-Brito C, Arauz A, Olmos L E, Ameriso S F, Díez-Tejedor E
Stroke Unit, Deparment of Neurology, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
Int J Stroke. 2014 Jun;9(4):503-13. doi: 10.1111/ijs.12070. Epub 2013 Jun 27.
Stroke is not only a leading cause of death worldwide but also a main cause of disability. In developing countries, its burden is increasing as a consequence of a higher life expectancy. Whereas stroke mortality has decreased in developed countries, in Latin America, stroke mortality rates continue to rise as well as its socioeconomic dramatic consequences. Therefore, it is necessary to implement stroke care and surveillance programs to better describe the epidemiology of stroke in these countries in order to improve therapeutic strategies. Advances in the understanding of the pathogenic processes of brain ischemia have resulted in development of effective therapies during the acute phase. These include reperfusion therapies (both intravenous thrombolysis and interventional endovascular approaches) and treatment in stroke units that, through application of management protocols directed to maintain homeostasis and avoid complications, helps to exert effective brain protection that decreases further cerebral damage. Some drugs may enhance protection, and besides, there is increasing knowledge about brain plasticity and repair mechanisms that take place for longer periods beyond the acute phase. These mechanisms are responsible for recovery in certain patients and are the focus of basic and clinical research at present. This paper discusses recovery strategies that have demonstrated clinical effect, or that are promising and need further study. This rapidly evolving field needs to be carefully and critically evaluated so that investment in patient care is grounded on well-proven strategies.
中风不仅是全球主要的死亡原因，也是导致残疾的主要原因。在发展中国家，由于预期寿命的提高，中风负担正在增加。虽然发达国家的中风死亡率有所下降，但在拉丁美洲，中风死亡率持续上升，其社会经济后果也极为严重。因此，有必要实施中风护理和监测计划，以便更好地描述这些国家的中风流行病学情况，从而改进治疗策略。对脑缺血致病过程认识的进展，促成了急性期有效治疗方法的发展。这些方法包括再灌注疗法（静脉溶栓和介入性血管内治疗）以及在中风单元进行的治疗，后者通过应用旨在维持体内平衡和避免并发症的管理方案，有助于实施有效的脑保护，减少进一步的脑损伤。一些药物可能会增强保护作用，此外，人们对急性期过后较长时间内发生的脑可塑性和修复机制的了解也越来越多。这些机制是某些患者康复的原因，也是目前基础和临床研究的重点。本文讨论了已证明具有临床效果、或有前景但需要进一步研究的康复策略。这个快速发展的领域需要仔细且严格地评估，以便将对患者护理的投入建立在经过充分验证的策略基础之上。
