《20161210 AIS溶栓后观察及处理》.pdf

AIS溶栓后观察及处理 香港大学深圳医院 神经内科 蔡继福 主要内容 •  卒中分类及AIS分型 •  卒中急性期一般处理 •  溶栓后观察及处理 –  溶栓后观察 ：NIHSS、血压 –  溶栓后血压管理 –  溶栓可能出现的并发症 ：出血、血管源性水肿 –  溶栓并发症的处理 –  注意事项 Classificaon of Stroke •  Hemorrhagic stroke –  Intracerebral Hemorrhage –  Subarachnoid Hemorrhage •  Ischemic Stroke Chinese Ischemic Stroke Subclassificaon General Supporve Care •  ABC •  Cardiac monitoring •  Posioning •  Hyperthermia •  BP management •  Glucose General Supporve Care •  ABC –  Supplemental oxygen to maintain SaO2 94% •  Cardiac monitoring –  Inial 24hrs cardiac monitoring for arrythmia •  Posioning –  Supine posion may offer advantage in cerebral perfusion. So it is recommended in those paents in whom oxygenaon can be mainaned –  Paents at the risk of raised ICP, head elevaon of 15 -30 degree is recommended •  Hyperthermia –  Sources of hyperthermia (T 38°C) should be idenfied and treated, and anpyrec medicaons should be administered to lower temperature in hyperthermic paents with stroke BP management Hypotenon •  Hypotension is rare and suggests another cause, such as cardiac arrhythmia or ischemia, aorc dissecon, or shock. •  If present, it is assosciated with poor outcome must be corrected. •  Euvolemia is preffered . •  NS is preffered as volume expanders •  Dextrose 0.45% NS lead to edema Glucose management •  Hypoglycemia : If present has to be corrected rapidly •  Hyperglycemia –  It is common . It is due to stress related impaired glucose metabolism. –  ADA recommends to maintain a level of 7.8-10 mmol/L IV t-PA •  Inclusion criteria