Neurology:急性缺血性卒中血管内治疗手术期间采用局部麻醉怎么样?

2018-08-17 杨中华 脑血管病及重症文献导读

在大动脉闭塞性急性缺血性卒中(acute ischemic stroke,AIS)的动脉内治疗(intra-arterial treatment,IAT)中,经常会采用麻醉支持。IAT期间麻醉支持的主要目的是为了降低患者的运动、增加患者的舒适性、便于迅速治疗以及尽量较少并发症的风险。IAT期间的麻醉管理有几种选择方案;全身麻醉(general anesthesia),清醒镇静(conscious

在大动脉闭塞性急性缺血性卒中(acute ischemic stroke,AIS)的动脉内治疗(intra-arterial treatment,IAT)中,经常会采用麻醉支持。IAT期间麻醉支持的主要目的是为了降低患者的运动、增加患者的舒适性、便于迅速治疗以及尽量较少并发症的风险。IAT期间的麻醉管理有几种选择方案;全身麻醉(general anesthesia),清醒镇静(conscious sedation,CS),或手术部位仅局部麻醉(local anesthesia,LA)。

CS通常被认为是IAT期间一种理想的妥协麻醉方式,因为CS能够保留患者配合的能力,舒适,和提高手术的速度(vs. LA),以及减少药物的使用(vs. GA)。尽管CS已经成为了IAT期间的常规策略,但是其对预后的作用尚不清楚。多中心随机对照试验MR CLEAN的事后分析显示GA对AIS患者动脉内手术的负面作用(vs 非GA,包括LA和CS)。

这个结果也被HERMES工作组的meta分析所证实。另一方面,最近发表的两项随机试验显示CS对IAT患者的神经功能改善没有帮助(vs GA)。我们不知道是否有研究把GA或CS与股骨沟穿刺部位仅LA相比。迄今为止,尚不清楚IAT期间采用CS是否对预后、并发症或手术时间产生正面的影响(vs. LA)。

2018年7月来自荷兰的Rob A. van de Graaf等在Neurology上公布了MR CLEAN登记研究(非MR CLEAN试验)结果,目的在于比较CS和LA对AIS IAT后功能预后和并发症的影响。

纳入的患者来自Erasmus大学医学中心,并且IAT期间采用了CS或LA。主要终点为顺序mRS(ordinal modified Rankin Scale)。

共146例IAT患者。与LA相比,CS与向mRS恶化转化有关(OR 0.4;95% CI 0.2 – 0.7)。与LA相比,CS组90天死亡率更高(OR 2.3;95% CI 1.0 – 5.2)。两组手术持续时间或手术相关并发症没有差异。

最终作者认为CS与不良预后和死亡率增加有关(vs LA)。此外,CS并不能降低手术持续时间或手术并发症。如果LA安全的话,AIS IAT期间采用CS是不能获益的。

译者注:这是首个比较LA和CS的登记研究,尽管还需要RCT研究证实,但是至少说明LA还是可行、安全甚至是有优势的。

原始出处:

[1]van de Graaf RA1, Samuels N2, Mulder MJHL2, et al. Conscious sedation or local anesthesia during endovascular treatment for acute ischemic stroke. Neurology. 2018 Jul 3;91(1):e19-e25. 

[2]Rabinstein AA1, Kallmes DF2. Optimal anesthetic strategy for endovascular stroke therapy: Begging for a good trial. Neurology. 2018 Jul 3;91(1):16-18.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (7)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=2053835, encodeId=8cfd205383594, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Sun Jun 16 10:35:00 CST 2019, time=2019-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893088, encodeId=5222189308877, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Fri Jul 19 04:35:00 CST 2019, time=2019-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806263, encodeId=5cfb1806263ed, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Thu Sep 06 12:35:00 CST 2018, time=2018-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000543, encodeId=b0dc200054392, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Jul 17 20:35:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405851, encodeId=ef88140585195, content=<a href='/topic/show?id=a5404e589d7' target=_blank style='color:#2F92EE;'>#局部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47589, encryptionId=a5404e589d7, topicName=局部)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d14c2562456, createdName=chg122, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1413719, encodeId=4d281413e19c9, content=<a href='/topic/show?id=37f74e6501f' target=_blank style='color:#2F92EE;'>#局部麻醉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47650, encryptionId=37f74e6501f, topicName=局部麻醉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0f3012244, createdName=zsyan, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026129, encodeId=dfb51026129a1, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 17 03:35:00 CST 2018, time=2018-08-17, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=2053835, encodeId=8cfd205383594, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Sun Jun 16 10:35:00 CST 2019, time=2019-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893088, encodeId=5222189308877, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Fri Jul 19 04:35:00 CST 2019, time=2019-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806263, encodeId=5cfb1806263ed, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Thu Sep 06 12:35:00 CST 2018, time=2018-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000543, encodeId=b0dc200054392, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Jul 17 20:35:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405851, encodeId=ef88140585195, content=<a href='/topic/show?id=a5404e589d7' target=_blank style='color:#2F92EE;'>#局部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47589, encryptionId=a5404e589d7, topicName=局部)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d14c2562456, createdName=chg122, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1413719, encodeId=4d281413e19c9, content=<a href='/topic/show?id=37f74e6501f' target=_blank style='color:#2F92EE;'>#局部麻醉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47650, encryptionId=37f74e6501f, topicName=局部麻醉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0f3012244, createdName=zsyan, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026129, encodeId=dfb51026129a1, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 17 03:35:00 CST 2018, time=2018-08-17, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=2053835, encodeId=8cfd205383594, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Sun Jun 16 10:35:00 CST 2019, time=2019-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893088, encodeId=5222189308877, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Fri Jul 19 04:35:00 CST 2019, time=2019-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806263, encodeId=5cfb1806263ed, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Thu Sep 06 12:35:00 CST 2018, time=2018-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000543, encodeId=b0dc200054392, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Jul 17 20:35:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405851, encodeId=ef88140585195, content=<a href='/topic/show?id=a5404e589d7' target=_blank style='color:#2F92EE;'>#局部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47589, encryptionId=a5404e589d7, topicName=局部)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d14c2562456, createdName=chg122, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1413719, encodeId=4d281413e19c9, content=<a href='/topic/show?id=37f74e6501f' target=_blank style='color:#2F92EE;'>#局部麻醉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47650, encryptionId=37f74e6501f, topicName=局部麻醉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0f3012244, createdName=zsyan, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026129, encodeId=dfb51026129a1, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 17 03:35:00 CST 2018, time=2018-08-17, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=2053835, encodeId=8cfd205383594, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Sun Jun 16 10:35:00 CST 2019, time=2019-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893088, encodeId=5222189308877, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Fri Jul 19 04:35:00 CST 2019, time=2019-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806263, encodeId=5cfb1806263ed, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Thu Sep 06 12:35:00 CST 2018, time=2018-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000543, encodeId=b0dc200054392, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Jul 17 20:35:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405851, encodeId=ef88140585195, content=<a href='/topic/show?id=a5404e589d7' target=_blank style='color:#2F92EE;'>#局部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47589, encryptionId=a5404e589d7, topicName=局部)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d14c2562456, createdName=chg122, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1413719, encodeId=4d281413e19c9, content=<a href='/topic/show?id=37f74e6501f' target=_blank style='color:#2F92EE;'>#局部麻醉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47650, encryptionId=37f74e6501f, topicName=局部麻醉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0f3012244, createdName=zsyan, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026129, encodeId=dfb51026129a1, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 17 03:35:00 CST 2018, time=2018-08-17, status=1, ipAttribution=)]
    2019-07-17 yinhl1978
  5. [GetPortalCommentsPageByObjectIdResponse(id=2053835, encodeId=8cfd205383594, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Sun Jun 16 10:35:00 CST 2019, time=2019-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893088, encodeId=5222189308877, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Fri Jul 19 04:35:00 CST 2019, time=2019-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806263, encodeId=5cfb1806263ed, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Thu Sep 06 12:35:00 CST 2018, time=2018-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000543, encodeId=b0dc200054392, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Jul 17 20:35:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405851, encodeId=ef88140585195, content=<a href='/topic/show?id=a5404e589d7' target=_blank style='color:#2F92EE;'>#局部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47589, encryptionId=a5404e589d7, topicName=局部)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d14c2562456, createdName=chg122, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1413719, encodeId=4d281413e19c9, content=<a href='/topic/show?id=37f74e6501f' target=_blank style='color:#2F92EE;'>#局部麻醉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47650, encryptionId=37f74e6501f, topicName=局部麻醉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0f3012244, createdName=zsyan, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026129, encodeId=dfb51026129a1, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 17 03:35:00 CST 2018, time=2018-08-17, status=1, ipAttribution=)]
    2018-08-18 chg122
  6. [GetPortalCommentsPageByObjectIdResponse(id=2053835, encodeId=8cfd205383594, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Sun Jun 16 10:35:00 CST 2019, time=2019-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893088, encodeId=5222189308877, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Fri Jul 19 04:35:00 CST 2019, time=2019-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806263, encodeId=5cfb1806263ed, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Thu Sep 06 12:35:00 CST 2018, time=2018-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000543, encodeId=b0dc200054392, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Jul 17 20:35:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405851, encodeId=ef88140585195, content=<a href='/topic/show?id=a5404e589d7' target=_blank style='color:#2F92EE;'>#局部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47589, encryptionId=a5404e589d7, topicName=局部)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d14c2562456, createdName=chg122, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1413719, encodeId=4d281413e19c9, content=<a href='/topic/show?id=37f74e6501f' target=_blank style='color:#2F92EE;'>#局部麻醉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47650, encryptionId=37f74e6501f, topicName=局部麻醉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0f3012244, createdName=zsyan, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026129, encodeId=dfb51026129a1, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 17 03:35:00 CST 2018, time=2018-08-17, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=2053835, encodeId=8cfd205383594, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Sun Jun 16 10:35:00 CST 2019, time=2019-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893088, encodeId=5222189308877, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Fri Jul 19 04:35:00 CST 2019, time=2019-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806263, encodeId=5cfb1806263ed, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Thu Sep 06 12:35:00 CST 2018, time=2018-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000543, encodeId=b0dc200054392, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Jul 17 20:35:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405851, encodeId=ef88140585195, content=<a href='/topic/show?id=a5404e589d7' target=_blank style='color:#2F92EE;'>#局部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47589, encryptionId=a5404e589d7, topicName=局部)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d14c2562456, createdName=chg122, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1413719, encodeId=4d281413e19c9, content=<a href='/topic/show?id=37f74e6501f' target=_blank style='color:#2F92EE;'>#局部麻醉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47650, encryptionId=37f74e6501f, topicName=局部麻醉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b0f3012244, createdName=zsyan, createdTime=Sat Aug 18 15:35:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026129, encodeId=dfb51026129a1, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 17 03:35:00 CST 2018, time=2018-08-17, status=1, ipAttribution=)]
    2018-08-17 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

相关资讯

Neurology CP:肝硬化相关血管病的发病机制

肝硬化对脑血管病的影响是多方面的,比如增加脑出血的风险,同时降低缺血性卒中的风险。尽管有报道显示颅内出血和血管畸形与肝脏疾病有关,其病理生理机制尚不清楚。肝硬化会引起于肝肺综合征(hepatopulmonary syndrome,HPS),后者表现为远端肺动脉扩张、扭曲,产生分流,甚至发生动静脉(arteriovenous,AV)畸形。

Lancet Neurol:高脑出血风险的缺血性卒中 哪种方案能走好钢丝绳?

对于脑出血高风险的缺血性卒中患者,使用药物预防心血管事件就像是在走钢丝绳,稍有不慎就万劫不复,是临床医生的一大挑战。2018年1月,发表于《Lancet Neurol》上的一项多中心、随机对照研究(PICASSO),考察了西洛他唑vs阿司匹林联合或不联合普罗布考对预防亚洲脑出血高风险的缺血性卒中患者心血管事件的效果。

JAHA:脂肪组织中亚油酸与缺血性卒中

由此可见,脂肪组织中亚油酸含量与总的缺血性卒中和大动脉粥样硬化引起的卒中风险成反比。

NEJM:POINT试验硬着陆

小卒中或TIA后90天内的缺血性卒中的风险为3-15%。在几项试验中,阿司匹林显示能够降低20%卒中复发风险。氯吡格雷通过P2Y12-受体途径阻断血小板聚集,能够协同阿司匹林的抗血小板聚集作用。在急性冠脉综合症中,阿司匹林联合氯吡格雷比单用阿司匹林能够更加有效地降低缺血事件的风险。

Lancet Neurol:缺血性卒中且房颤患者 有脑微出血还能抗凝吗?

具有缺血性卒中或短暂性脑缺血发作的房颤患者,如果存在脑微出血,抗凝治疗是否增加症状性颅内出血的风险。2018年6月,发表在《Lancet Neurol》的一项多中心观察性队列研究对此进行了调查。

Stroke:缺血性卒中和卒中亚型早期血压对脑卒中后认知障碍的影响!

由此可见,缺血性卒中早期血压较低或较高均与3个月PSCI风险增加有关。维持收缩压/舒张压在143-158/93-102mmHg有助于减少PSCI的发生。而大动脉硬化亚型和前循环梗死亚型与3个月PSCI风险增加相关。