改善血流动力学_缺血性卒中治疗被忽视的环节.pptVIP

rt-PA是最有效的治疗药物 Results Results Conclusions PGE1 increases the CBF of patients with chronic cerebral infarction without causing the intracerebral steal phenomenon. 结果显示应用前列地尔后，各脑缺血部位，包括额叶、颞叶、顶叶、枕叶、丘脑、纹状体、脑干、小脑等的脑血流量明显增加，具有显著的统计学意义，且部分患者的主观症状明显改善。 * Background? Over the last several years evidence has accumulated that in addition to embolism, a compromised cerebral blood flow may play an important role in causing transient ischemic attacks and ischemic stroke in patients with occlusion of the internal carotid artery. This evidence is found in both clinical features and ancillary investigations, particularly measurements of cerebral blood flow. Summary of Review? On the basis of 20 follow-up studies in patients with transient ischemic attacks or minor ischemic stroke associated with an occluded carotid artery, the annual risk of stroke was 5.5% (95% confidence interval [CI], 5.0% to 6.0%), and that of ipsilateral stroke (distinguished in 11 of the 20 studies) was 2.1% (95% CI, 1.6% to 2.8%). Patients with a compromised cerebral blood flow as measured by positron emission tomography, single-photon emission CT, transcranial Doppler, or stable xenon CT (six studies) have an even higher annual risk of stroke (all strokes: 12.5%; 95% CI, 8.9% to 17.6%; ipsilateral stroke: 9.5%; 95% CI, 6.4% to 14.0%). Conclusions? Because a compromised cerebral blood flow may be an important causal factor in patients with symptomatic carotid artery occlusion, medical and surgical options for treatment are reviewed in this light. ? * * 1、Carlson LA．Eriksson I Femoral— artery infusion of prostagiadin E1 in severe peripheral vascular disease．Lancet， 1983，1：155—159 –扩血管 2、Tamura DY,Moore EE,Partrick DA,et al.Prostaglandin E1 attenuates cyto-toxic mechanisms of primed neutrophils.Shock,1998,9:171-176. 3、Hafez T, et al. The effect of intraportal prostaglandin E1 on adhesion molecule expression, inflammatory modulator function, and histology in canine hepatic ischemia/reperfusion injury.