Medical and Surgical Prevention of Stroke

腦中風的內科及外科的預防

馮清世(Chin-Shih Fong)

《Acta Neurologica Taiwanica》 12卷4期 (2003/12) Pp. 211-220

摘要

腦中風是一常見與嚴重的疾病，大多數的腦中風並無有效的治療方式，故腦中風的預防是一個重要的課題。初級與次級腦中風預防試驗顯示降低高血壓病人的血壓可減少腦中風的危險。另有證據發現發生心肌梗塞後的病人服用warfarin或statin藥物可減少腦中風的發生率。在非瓣膜性心房顫動的病人若合併有其他的危險因子，需服用warfarin。控制糖尿病病人的高血壓是必要的，且嚴格控制血糖可減少小血管的併發症。有高膽固醇血症的病人，降低血中的膽固醇可減少腦中風的發生。頸動脈高於百分之七十狹窄的症狀性病人接受頸動脈內膜切除術可減少腦中風的發生，然而頸動脈內膜切除術對於頸動脈狹窄而無症狀性的病人，在腦中風的預防效果尚不清楚。曾有腦缺血症狀的病人服用sapirin或clopidogrel可減少再發生腦中風的危險。抽煙與與飲酒過量應該避免，他們會增加腦中風的發生。不建議曾有腦中風病史或有腦中風危險因子的女性使用含有雌激素的荷爾蒙補充療法服用口服避孕藥。

關鍵字

腦中風 ； 預防

並列摘要

Stroke prevention is an important subject because stroke is a frequent and severe disorder, and there are no effective treatments for most of stroke. Primary and secondary prevention trials have shown that reducing blood pressure in hypertensive individuals reduces stroke risk. Evidence for stroke reduction exists for using warfarin or statin agents for patients after myocardial infarction. Warfarin is indicated for patients with valvular heart disease and nonvalvular atrial fibrillation who have specific risk factors. Careful control of arterial hypertension in diabetics is recommended, together with a strict glycemic control to reduce systemic microvascular complication. Lowering serum cholesterol in patients with hypercholesterolemia reduces the risk of stroke. Carotid endarterectomy reduces the risk of stroke in symptomatic patients with at least 70 percent stenosis of carotid artery. The endarterectomy with perioperative stroke-related morbidity and mortality of 3% or less is considered for patients with asymptomatic carotid lesion of at least 60% stenosis. In patients with cerebral ischemic symptoms, aspirin or clopidogrel reduce the risk for recurrent stroke. Cigarette smoking and heavy drinking are associated with an increased risk of stroke, and should be avoided. Estrogen prescribed in hormone replacement or oral contraceptives therapies is not recommended in women with prior stroke events or with risk factors for stroke.

並列關鍵字

Stroke ； Carotid artery disease ； Risk factor ； Prevention