Department of Anaesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genova, Italy.
Dipartimento di Scienze Chirurgiche Diagnostiche Integrate, University of Genova, Genova, Italy.
Eur Heart J Acute Cardiovasc Care. 2022 Mar 16;11(3):258-268. doi: 10.1093/ehjacc/zuac004.
Acute ischaemic stroke (AIS) is responsible for almost 90% of all strokes and is one of the leading causes of death and disability. Acute ischaemic stroke is caused by a critical alteration in focal cerebral blood flow (ischaemia) from a variety of causes, resulting in infarction. The primary cerebral injury due to AIS occurs in the first hours, therefore early reperfusion importantly impacts on patient outcome ('Time is brain' concept). Secondary cerebral damage progressively evolves over the following hours and days due to cerebral oedema, haemorrhagic transformation, and cerebral inflammation. Systemic complications, such as pneumonia, sepsis, and deep venous thrombosis, could also affect outcome. The risk of a recurrent ischaemic stroke is in particular high in the first days, which necessitate particular attention. The role of intensive care unit physicians is therefore to avoid or reduce the risk of secondary damage, especially in the areas where the brain is functionally impaired and 'at risk' of further injury. Therapeutic strategies therefore consist of restoration of blood flow and a bundle of medical, endovascular, and surgical strategies, which-when applied in a timely and consistent manner-can prevent secondary deterioration due to cerebral and systemic complications and recurrent stroke and improve short- and long-term outcomes. A multidisciplinary collaboration between neurosurgeons, interventional radiologists, neurologists, and intensivists is necessary to elaborate the best strategy for the treatment of these patients.
急性缺血性脑卒中（AIS）占所有脑卒中的近 90%，是死亡和残疾的主要原因之一。急性缺血性脑卒中是由各种原因导致的局灶性脑血流（缺血）的严重改变引起的，导致梗死。由于 AIS 导致的原发性脑损伤发生在最初的几个小时内，因此早期再灌注对患者的预后有重要影响（“时间就是大脑”的概念）。继发性脑损伤在接下来的几个小时和几天内由于脑水肿、出血性转化和脑炎症而逐渐发展。全身性并发症，如肺炎、败血症和深静脉血栓形成，也可能影响预后。在最初几天内，再次发生缺血性脑卒中的风险特别高，因此需要特别注意。因此，重症监护病房医生的作用是避免或降低继发性损伤的风险，特别是在大脑功能受损且“有进一步损伤风险”的区域。治疗策略因此包括恢复血流和一整套医疗、血管内和手术策略，这些策略如果及时和一致地应用，可以防止由于脑和全身并发症以及再次发生脑卒中而导致的继发性恶化，并改善短期和长期预后。神经外科医生、介入放射科医生、神经科医生和重症监护医生之间的多学科合作对于制定这些患者的最佳治疗策略是必要的。
