原作者： Feng Xiao, MD (肖鋒) 文章來源： 中華急診醫學雜志編輯部 發布日期：2013-03-14
Title: 2013 Stroke Guidelines: Revised and New Recommendations (Part 1: Pre-Intervention)
題目：2013年腦卒中指南：修改的和新的建議摘要（第一部分：介入治療前）
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，美國心臟病協會（AHA）和美國腦卒中協會（ASA）聯合發表了對急性腦卒中早期處理的新指南，同時廢棄了2007年的指南和2009年對其的更新。
1. Prehospital Care 院前處理
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.
應將病人轉運到最近的認證的初級或高級腦卒中中心。如沒有這樣的機構，要送到能夠提供緊急腦卒中處理的醫院。
In some instances, this may involve air medical transport and hospital bypass.
在某些情況下，可能需要空中醫療轉運和繞過幾個醫院。
Field personnel should notify the receiving facility that a potential stroke patient will be arriving to facilitate resource mobilization.
現場醫務人員要通知接受醫院可能有一個腦卒中的病人，以幫助醫院及時調動資源。
2. Stroke Center Designation/Quality Improvement 腦卒中中心的認定和質量改善
The section highlights the emergence of comprehensive stroke centers and their integration into regional systems of care.
這一部分強調了建立高級腦卒中中心并與地區急救體系相融合的重要性。
Teleradiology is developing as a resource while data continue to support the use of telemedicine and quality improvement processes in stroke care.
遠程放射學將成為一個資源，同時有資料繼續支持遠程醫學和質量改善在腦卒中治療中的作用。
3. Emergency Evaluation and Diagnosis 急診評估和診斷
Fibrinolytic therapy should now not be delayed while awaiting laboratory test results other than a glucose determination.
除明確血糖外，不要因為等待其它實驗結果而拖延溶栓治療。
4. Imaging: Symptoms Unresolved 影像：癥狀沒有完全改善
Noncontrast CT or MRI can exclude hemorrhage and hypodensity involving more than one third of the middle cerebral artery territory prior to fibrinolytic therapy.
非增強CT或MRI能夠在給溶栓前排出出血或發現超過1／3以上的大腦中動脈區域的低密度區。
5. Imaging: Symptoms Resolved影像：癥狀完全改善
MRI remains preferred over CT for imaging patients with suspected TIAs because it can provide insight into whether a stroke has occurred.
在懷疑有TIA時，MRI要優于CT，因為它能夠提供病人是否已經有梗塞的信息。
6. Supportive Care/Addressing Complications 支持療法／強調合并癥
Cardiac monitoring for at least 24 hours is recommended to screen for arrhythmias.
心臟監測至少要24小時，以發現心律失常。
Hypovolemia should be corrected with IV saline.
用生理鹽水糾正低容量。
supplemental oxygen should be administered to achieve > 94% saturation.
給氧以保證血氧飽和度超過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，要進行糾正，爭取到正常；高血糖要糾正到140－180mg／dl范圍內。
See our previous pearl (3-11-2013) for new recommendations for BP management. “Blood Pressure Management Updates from the 2013 Acute Ischemic Stroke Guideline”
參考我們在2013年3月11日發表的必知以了解對血壓處理的新建議。“2013年急性缺血性腦梗塞指南對血壓處理的更新”
Reference 參考文獻:
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
?
