课件：Ischemic.ppt

Treatment 急性期治疗（Treatment in acute stage） 治疗原则： 超早期治疗--力争溶栓； 综合保护治疗； 个体化治疗； 整体化治疗； 对危险因素及时予以预防性干预措施。 Treatment 超早期溶栓治疗 目的：溶解血栓；迅速恢复梗死区血流灌注；减轻神经元损伤。（6h） complications: Hemorrhage, reperfusion damage and brain edema, reocclusion. Treatment 超早期溶栓治疗 Thrombolytic agents :Urokinase (UK), Straptokinase (SK), recombinant tissue plasminogen activator (rt-PA) Treatment 超早期溶栓治疗 Indications: Age 75 no disturbance of consciousness within 6h(or 12h for progressive stroke) of onset Bp 200/120mmHg no hemorrhage shown on CT scanning exclusion of TIA no other hemorrhagic diseases Treatment Antiplatelet agents The regime is as described in the section of TIA. Anticoagulation agents: to prevent the progression of thrombosis. The agents used are the same as mentioned in the section of TIA. Fibrinogen degradation therapy: 降纤酶 (Defibrase), 巴曲酶 (Batroxobin), 安洛克酶(Ancrod)和引激酶。 Treatment Neuroprotective agents: 抗自由基：V-E V-C 甘露醇 激素等 抑制脑代谢—急性期时应降低脑代谢，减少脑细胞耗氧量使缺血区血流量增加 钙离子拮抗剂：西比灵 尼莫地平等 亚低温 胰岛素维持血糖正常低限水平 Treatment Other forms of medical treatment: such as therapies aimed at improving blood flow: hemodilution, metabolic improving agents-ATP, Co-A, 脑活素等。 Treatment Surgical treatment General treatment ICU: monitoring ECG, Bp, R, P, etc. Antiedema agents Preventing infection Physical therapy and rehabilitation Preventive measures 腔隙性脑梗塞-Lacunar Infarction Concept： Small penetrating arteries located deep in the brain may become occluded as a result of changes in the vessel wall induced by chronic hypertension and atherosclerosis. 是指发生在大脑半球深部白质及脑干的缺血性微梗死因脑组织缺血、坏死、液化并由吞噬细胞移走而形成腔隙，占脑梗死的。多见于基底节区、放射冠、丘脑、脑干等部位。 腔隙性脑梗塞-Lacunar Infarction Common types: 纯运动性卒中(Pure motor hemiparesis, PMH) 纯感觉性卒(Pure sensory stroke, PSS) 共济失调性轻偏瘫(Ataxic-hemiparesis, AH) 构音障碍-手笨拙综合征 (Dysarthric- clumsy hand s