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[急性血管内卒中治疗的围介入期管理]

[Peri-interventional management of acute endovascular stroke treatment].

作者信息

Schönenberger S, Bösel J

机构信息

Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.

出版信息

Nervenarzt. 2015 Oct;86(10):1217-25. doi: 10.1007/s00115-015-4269-x.

Abstract

Due to the ground breaking consistent evidence that supports the effect of endovascular stroke treatment (EST), many acute care hospitals and stroke centers will have to be prepared to provide this treatment in an optimal way within the coming years. In addition to the intervention itself, patient preparation, stabilization and monitoring during the treatment as well as the aftercare represent significant challenges and have mostly not yet been sufficiently investigated. Under these aspects, the questions of optimal sedation and airway management have received the highest attention. Based on retrospective study results it already seems to be justified, respecting certain criteria, to prefer EST with the patient under conscious sedation (CS) in comparison to general anesthesia (GA) and to only switch to GA in cases of emergency until this question has been clarified by prospective studies. This and other aspects of peri-interventional management, such as logistics, monitoring, blood pressure, ventilation settings, postprocedural steps of intensive or stroke unit care and imaging follow-up are summarized in this overview. The clinical and radiological selection of patients and thus the decision for intervention or technical aspects of the intervention itself will not be part of this article.

摘要

由于有突破性的一致证据支持血管内卒中治疗(EST)的效果,许多急症医院和卒中中心在未来几年将不得不做好准备,以最佳方式提供这种治疗。除了干预本身,治疗期间的患者准备、稳定和监测以及术后护理都构成重大挑战,而且大多尚未得到充分研究。在这些方面,最佳镇静和气道管理问题受到了最高关注。基于回顾性研究结果,在符合某些标准的情况下,与全身麻醉(GA)相比,选择在清醒镇静(CS)下对患者进行EST似乎是合理的,并且在这个问题通过前瞻性研究得到澄清之前,仅在紧急情况下才转为GA。本综述总结了围介入管理的这一及其他方面,如后勤、监测、血压、通气设置、重症监护或卒中单元护理的术后步骤以及影像学随访。患者的临床和影像学选择以及因此而做出的干预决策或干预本身的技术方面不在本文讨论范围内。

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