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2013年脑卒中指南:修改的和新的建议摘要(第一部分:介入治疗前)
原作者: Feng Xiao, MD (肖锋) 文章来源: 中华急诊医学杂志编辑部 发布日期:2013-03-14

Title: 2013 Stroke Guidelines: Revised and New Recommendations (Part 1: Pre-Intervention)
题目:2013年脑卒中指南:修改的和新的建议摘要(第一部分:介入治疗前)


On January 31, 2013, the American Heart Association (AHA) and the American Stroke Association (ASA) released new recommendations for the early management of acute stroke, replacing the 2007 guidelines and subsequent 2009 update.
在2013年1月31日,美国心脏病协会(AHA)和美国脑卒中协会(ASA)联合发表了对急性脑卒中早期处理的新指南,同时废弃了2007年的指南和2009年对其的更新。
1. Prehospital Care 院前处理
Patients should be transported to the closest certified primary or comprehensive stroke center or, when such an institution is not available, the closest facility offering emergency stroke care.
应将病人转运到最近的认证的初级或高级脑卒中中心。如没有这样的机构,要送到能够提供紧急脑卒中处理的医院。
In some instances, this may involve air medical transport and hospital bypass.
在某些情况下,可能需要空中医疗转运和绕过几个医院。
Field personnel should notify the receiving facility that a potential stroke patient will be arriving to facilitate resource mobilization.
现场医务人员要通知接受医院可能有一个脑卒中的病人,以帮助医院及时调动资源。
2. Stroke Center Designation/Quality Improvement 脑卒中中心的认定和质量改善
The section highlights the emergence of comprehensive stroke centers and their integration into regional systems of care.
这一部分强调了建立高级脑卒中中心并与地区急救体系相融合的重要性。
Teleradiology is developing as a resource while data continue to support the use of telemedicine and quality improvement processes in stroke care.
远程放射学将成为一个资源,同时有资料继续支持远程医学和质量改善在脑卒中治疗中的作用。
3. Emergency Evaluation and Diagnosis 急诊评估和诊断
Fibrinolytic therapy should now not be delayed while awaiting laboratory test results other than a glucose determination.
除明确血糖外,不要因为等待其它实验结果而拖延溶栓治疗。
4. Imaging: Symptoms Unresolved 影像:症状没有完全改善
Noncontrast CT or MRI can exclude hemorrhage and hypodensity involving more than one third of the middle cerebral artery territory prior to fibrinolytic therapy.
非增强CT或MRI能够在给溶栓前排出出血或发现超过1/3以上的大脑中动脉区域的低密度区。
5. Imaging: Symptoms Resolved影像:症状完全改善
MRI remains preferred over CT for imaging patients with suspected TIAs because it can provide insight into whether a stroke has occurred.
在怀疑有TIA时,MRI要优于CT,因为它能够提供病人是否已经有梗塞的信息。
6. Supportive Care/Addressing Complications 支持疗法/强调合并症
Cardiac monitoring for at least 24 hours is recommended to screen for arrhythmias.
心脏监测至少要24小时,以发现心律失常。
Hypovolemia should be corrected with IV saline.
用生理盐水纠正低容量。
supplemental oxygen should be administered to achieve > 94% saturation.
给氧以保证血氧饱和度超过94%。
Blood glucose < 60 mg/dL should be treated, ideally to normal, and hyperglycemia should be treated to a range of 140-180 mg/dL.
血糖如低于60mg/dl,要进行纠正,争取到正常;高血糖要纠正到140-180mg/dl范围内。
See our previous pearl (3-11-2013) for new recommendations for BP management. “Blood Pressure Management Updates from the 2013 Acute Ischemic Stroke Guideline”
参考我们在2013年3月11日发表的必知以了解对血压处理的新建议。“2013年急性缺血性脑梗塞指南对血压处理的更新”

Reference 参考文献:
Edward C. Jauch, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947.

http://www.ncbi.nlm.nih.gov/pubmed/23370205

文章来源:中华急诊医学杂志编辑部