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[中风]

[Stroke].

作者信息

Reinhart W H

机构信息

Medizinische Klinik, Kantonsspital Chur.

出版信息

Schweiz Med Wochenschr. 1993 Apr 24;123(16):775-82.

PMID:8488381
Abstract

Stroke is an ischemic event in 80% and hemorrhagic in 20%, which can be distinguished by computed tomography of the brain. Unfortunately, no routinely applicable therapy is available for stroke. Several thrombolysis studies are underway and their results will become available in the next few years. Hemodilution has been abandoned except for hematocrits above 50%. Calcium antagonists such as nimodipine reduce vascular spasms after subarachnoidal hemorrhage, but their administration after ischemic stroke is unsuccessful. A new experimental approach is offered by glutamate receptor antagonists, which may prevent cell damage induced by the excitatory amino acid glutamate. In the case of cardio-embolic stroke, heparin should be started after 48 hours. Hypertension should only be treated above values of 200/120 mm Hg, with short-acting intravenous drugs. Because of the limited therapeutic options for completed stroke, primary prevention (treatment of hypertension, anticoagulation for atrial fibrillation) and secondary prevention after transitory ischemic attacks (endarterectomy for carotid stenosis > 70%, aspirin) should be intensified.

摘要

80%的中风为缺血性事件,20%为出血性事件,可通过脑计算机断层扫描加以区分。遗憾的是,目前尚无常规适用的中风治疗方法。多项溶栓研究正在进行中,其结果将在未来几年公布。除了血细胞比容高于50%的情况外,血液稀释疗法已被摒弃。像尼莫地平这样的钙拮抗剂可减轻蛛网膜下腔出血后的血管痉挛,但在缺血性中风后使用却未取得成功。谷氨酸受体拮抗剂提供了一种新的实验方法,它可能预防由兴奋性氨基酸谷氨酸诱导的细胞损伤。对于心源性栓塞性中风,应在48小时后开始使用肝素。仅在血压高于200/120毫米汞柱时,才用短效静脉药物治疗高血压。由于完全性中风的治疗选择有限,应加强一级预防(治疗高血压、对心房颤动进行抗凝)和短暂性脑缺血发作后的二级预防(对颈动脉狭窄>70%进行动脉内膜切除术、使用阿司匹林)。

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