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 2: Interventions)
題目：2013年腦卒中指南：修改的和新的建議摘要（第二部分：介入治療）
7. Intravenous Fibrinolysis 靜脈溶栓
Eligible patients should receive rtPA therapy as soon as possible, ideally within 60 minutes of hospital arrival.
有適應癥的病人應盡快接受tPA治療，最理想的是在到達醫院后60分鐘內。
IV fibrinolysis can be considered in patients with rapidly improving symptoms, mild stroke deficits, major surgery within the past 3 months, and recent myocardial infarction.
下列情況也可以考慮應用靜脈溶栓：癥狀很快改善，輕度的腦梗塞癥狀，過去的3個月內做過小手術，和近期心梗。
The effectiveness of sonothrombolysis for treatment of patients with acute stroke is not well established.
超聲溶栓在治療急性腦卒中中的效果還不清楚。
rtPA is not recommended in patients taking direct thrombin inhibitors or direct factor Xa inhibitors unless tests including activated partial thromboplastin time, INR, platelet count, clotting time, thrombin time, or direct factor Xa activity are normal; or they haven't taken these agents for > 2 days.
如病人使用直接凝血酶或Xa因子抑制劑，不要用tPA，除非下列檢查正常或病人兩天以上沒有用這些藥：部分活性凝血酶源時間，INR，血小板計數，凝血時間，凝血酶時間，或直接Xa因子活性。
8. Endovascular Interventions 血管內介入治療
Select patients with MCA strokes of < 6 hours duration who are not IV rtPA candidates can benefit from intra-arterial fibrinolysis.
對于發病6個小時內不適于靜脈tPA的大腦中動脈腦梗卒中病人，可以考慮用動脈內溶栓。
Minimizing delays in administering intra-arterial fibrinolysis improves outcomes.
縮短拖延動脈內溶栓可以改善預后。
Stent retrievers are preferred to coil retrievers.
支架取栓要優于線圈取栓。
In patients with a large artery stroke who have not responded to IV fibrinolysis, intra-arterial fibrinolysis and mechanical thrombectomy are reasonable approaches.
如病人患有大動脈腦卒中又對靜脈溶栓無效，可以考慮用動脈內溶栓或機械取栓術。
Emergent intracranial angioplasty and/or shunting do not have proven usefulness, nor does the use of these approaches in the extracranial carotid or vertebral arteries in unselected patients.
緊急顱內血管擴張和／或分流沒有明確的臨床效果，它們在顱外頸動脈或椎動脈中的應用也是一樣。
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.
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
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