Langhorne P, Stott D J
Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, Scotland.
Drugs Aging. 1995 Jun;6(6):445-55. doi: 10.2165/00002512-199506060-00004.
The optimal management of acute cerebral infarction requires consideration of the diagnosis, aetiology, identification of problems, general and specific aspects of care, and prevention of further vascular events. Stroke is a clinical diagnosis but cranial computed tomography (CT) scanning is invaluable to exclude the possibility of cerebral haemorrhage or where the diagnosis is uncertain. Good general care under a specialist multidisciplinary team can reduce mortality and the need for institutional care. Despite promising results from experimental studies, no routine drug therapies have yet shown clinical benefit in acute stroke. Several large trials are currently evaluating anticoagulant, antiplatelet, thrombolytic and neuroprotective agents. Many other proposed therapies have been subject to limited evaluation. Aspirin has a proven role in the prevention of further vascular events after a stroke or transient ischaemic attack. Warfarin, and to a lesser extent aspirin, can prevent recurrent events in patients with nonrheumatic atrial fibrillation. Concerns remain about the safety of warfarin in routine geriatric medical practice. The risk of recurrent stroke in patients with a symptomatic severe carotid artery stenosis is greatly reduced by endarterectomy.
急性脑梗死的最佳治疗需要考虑诊断、病因、问题识别、护理的一般和特殊方面，以及预防进一步的血管事件。中风是一种临床诊断，但头颅计算机断层扫描（CT）对于排除脑出血的可能性或诊断不确定时非常重要。在专科多学科团队的良好综合护理可以降低死亡率和对机构护理的需求。尽管实验研究取得了有希望的结果，但尚无常规药物疗法在急性中风中显示出临床益处。目前有几项大型试验正在评估抗凝剂、抗血小板药物、溶栓剂和神经保护剂。许多其他提议的疗法评估有限。阿司匹林在预防中风或短暂性脑缺血发作后的进一步血管事件中已被证明有作用。华法林以及在较小程度上的阿司匹林，可以预防非风湿性心房颤动患者的复发事件。在常规老年医学实践中，对华法林的安全性仍存在担忧。有症状的严重颈动脉狭窄患者行内膜切除术可大大降低复发性中风的风险。
