急性缺血性腦中風之早期治療

Early Management of Acute Ischemic Stroke

洪嘉蔚(Chia-Wei Hung)

《北市醫學雜誌》 4卷9_S期 (2007/12) Pp. 890-898

https://doi.org/10.6200/TCMJ.2007.4.9.13

摘要

缺血性腦中風是神經科最常見之急症，除了早期就醫、早期診斷，如何在黃金期內使阻塞的血管暢通，挽救神經細胞，並避免腦出血之後遺症，是治療主要的重點。美國心臟協會(American Heart Association)及美國腦中風協會(American Stroke Association)在2007年發表了最新的治療準則，靜脈血栓溶解劑rtPA仍是唯一有效的治療藥物。中風發作後24至48小時內應開始口服抗血小板凝結劑aspirin，因其能預防二次中風，改善病人預後。但需注意aspirin無法取代rtPA，且注射rtPA的病人24小時內不可服用抗血小板凝結劑或抗凝血劑。沒有證據顯示抗凝血劑和神經元保護劑可以治療急性缺血性腦中風，有些研究結果甚至顯示有害。目前台灣腦中風學會正在發展本土的中風治療準則。

關鍵字

缺血性腦中風 ； 靜脈血栓溶解劑 ； 抗凝血劑 ； 抗血小板凝結劑 ； 神經元保護劑

並列摘要

Ischemic stroke is the most common neurological emergency. Current treatment strategies focus on receiving early reperfusion therapy. In the 2007 guidelines from American Heart Association and American Stroke Association, rtPA is still the only recommended medical therapy for treatment of patients with acute ischemic stroke. The oral administration of aspirin within 24 to 48 hours after stroke onset is recommended for its role in prevention of recurrent stroke. Aspirin should not be considered a substitute for rtPA. Initiation of antiplatelet and anticoagulant therapy within 24 hours of treatment with intravenously administered rtPA is not recommended. Because the effectiveness of anticoagulants and neuroprotective agents has not been established, these medications are not recommended. The Taiwan version of early management of acute ischemic stroke is being developed by the Taiwan Stroke Society.

並列關鍵字

ischemic stroke ； intravenous thrombolysis ； anticoagulant ； antiplatelet agent ； neuroprotective agent