急性缺血性腦中風之一般處理原則指引

Guidelines for the General Management of Patients with Acute Ischemic Stroke

張寓智(Yeu-Jhy Chang) ； 劉祥仁(Shan-Jin Ryu) ； 陳俊榮(Jiunn-Rong Chen) ； 胡漢華(Han-Hwa Hu) ； 葉炳強(Ping-Keung Yip) ； 邱德發(Te-Fa Chiu)

《Acta Neurologica Taiwanica》 17卷4期 (2008/12) Pp. 275-294

https://doi.org/10.29819/ANT.200812.0011

摘要

本第二版「急性缺血性腦中風之一般處理原則」指引爲根據2002年台灣腦中風學會第一版指引增修，是依照財團法人國家衛生研究院（以下簡稱國衛院）及專家所建議之「建立健保門住急診給付前十大疾病臨床指引」的共同統一格式所修訂完成，其內容除了再參酌本土專家建議之外，並參考最新版本的美國和歐洲腦中風學術團體指引撰寫完成，最後由國衛院所評鑑修改完成後公告。適用此指引的病患爲急性缺血性腦中風患者，且只適用其中的一般性處理，亞急性或慢性期，或特殊性缺血性腦中風患者之處置另有專文介紹。急性缺血性腦中風的處置大多需要在極短的時間內完成，所以建議負責提供腦中風診療的醫院最好設置腦中風病房或單位，且應該由專精鈴腦中風照顧之醫療、護理及治療專業人員負責規劃及執行，以提供整合性的多種專科醫療團隊照護。在症狀發生後應盡快將病人送到醫院，並儘快執行腦部電腦斷層攝影及相關評估及檢查以做爲急性介入治療選擇時的必要引導參考。急性缺血性腦中風三小時內靜脈內注射組織胞漿素原活化劑溶栓治療可以有效降低殘障度。有持續性缺血性腦中風症狀病人，應該立即閉始給予抗血小板治療，一般爲aspirin。有持續性或偶發性心房纖維顫動及缺血性腦中風病人，建議使用調整劑量的warfarin（INR範圍爲2.0-3.0）治療，以預防栓塞復發。並無臨床證據足以建議常規使用肝素抗凝血劑及理論上可以減少腦神經傷害的藥物，包括類固醇、神經元保護劑、血漿容積擴張劑、巴比妥鹽及streptokinas。等治療方式。

關鍵字

急性缺血性腦中風 ； 一般處理原則 ； 台灣指引

並列摘要

The content of the second edition of ”Guideline for General Management of Patients with Acute Ischemic Stroke” was amended from the first edition of that of the Taiwan Stroke Society in 2002. The format of the guideline followed the common unified instruction for the project of ”The establishment of clinical guidelines for the top 10 payments diseases of the National Health Insurance at the departments of inpatients, emergency and outpatients” as recommended by the National Health Research Institutes (NHRI). The guideline was revised after several official meetings of local experts, as well as citation from the latest updated guidelines of the United States and the European Stroke academic groups. Before editing notice, the final evaluation was performed by the review team of the NHRI. Application of the guideline is dedicated or designated to the patients with acute ischemic stroke, and which is applied only limited to the general management. Guidelines for subacute or chronic phase, or the specific treatment for ischemic stroke patients will be published in separated articles. Management of most of the needs for patients with acute ischemic stroke must be completed in a very short period of time. It is recommended that hospitals providing stroke service to set up stroke unit, and to organize an integrated stroke team consisting of specialists from multiple disciplines. Upon arrival to the hospitals, patients should undergo the brain computed tomography, and related examinations and assessment as soon as possible to guide the choice of treatment reference for acute intervention. Intravenous recombinant tissue plasminogen activator treatment within three hours is effective in reducing disability for patients with acute ischemic stroke. Ischemic stroke patients with or without persistent symptoms should start antiplatelet therapy immediately, generally aspirin. Doseadjusted warfarin (INR range of 2.0-3.0) is recommended for ischemic stroke patients with persistent or paroxysmal atrial fibrillation to prevent secondary embolism. The routine use of heparin and drugs theoretically preventing further brain injury, including steroids, neuroprotectants, plasma volume expanders, barbiturates, and streptokinase, has not been proven benefits for recommendation.

並列關鍵字

Acute ischemic stroke ； General management ； Taiwan guidelines