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急性缺血性卒中的静脉溶栓治疗
Intravenous Thrombolytic Therapy for Acute Ischemic Stroke


Lawrence R. Wechsler ... 心脑血管疾病 • 2011.06.02
相关阅读
• 将卒中静脉溶栓的时间窗延长至4.5小时之后 • 卒中发生后9小时内灌注成像引导溶栓 • 溶栓治疗轻度卒中的益处尚不清楚 • MRI引导下阿替普酶静脉给药治疗卒中——仍然卡在时间上 • 急性卒中头部体位的集群随机交叉试验

杂志的这一部分以一个包含有推荐的治疗方案的病例摘要开篇。随后讨论了其临床问题和这类疗法获益的机制。文章归纳总结了有关的主要临床研究、该治疗方案的临床应用及其潜在的不良反应。如果有相关的正式指南,作者将在文中提供。最后以作者的临床建议结尾。


一名81岁的男性患者因“言语困难伴右侧肢体无力”于上午9:15到达急诊室。患者清晨睡醒时尚无症状,于上午8:00进食早餐时,患者妻子发现患者从椅子上滑下,跌倒在地,并且不能讲话,右侧上肢及下肢均不能移动。患者妻子拨通911急救电话将患者送至急诊室。患者几次试图讲话,但是说话内容无法理解。随后患者可以移动右侧上下肢,但是不能抬离床面。颅脑计算机断层扫描(CT)检查未见出血,也没有早期缺血性改变征象,血压160/90 mmHg,血小板计数、血糖水平、凝血酶原时间均正常。患者于上午10:00完成影像学检查返回急诊室,一位神经科医师会诊,确定初步诊断为急性缺血性卒中,并建议立即开始静脉内溶栓治疗。





作者信息

Lawrence R. Wechsler, M.D.
From the Department of Neurology, University of Pittsburgh Medical School, Pittsburgh. Address reprint requests to Dr. Wechsler at the Department of Neurology, 811 Lillian Kaufmann Bldg., 3471 Fifth Ave., Pittsburgh, PA 15213, or at wechslerlr@upmc.edu.

 

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