重症脑梗死患者超急性期再灌注治疗研究进展

Research progress on hyperacute reperfusion therapies for patients with severe ischemic stroke

重症脑梗死表现为神经功能重度缺损,可伴呼吸、循环等多系统严重功能障碍,导致严重残疾甚至死亡。该文系统分析了近20年来国内外重症脑梗死再灌注治疗相关研究,总结了最新诊疗指南和专家共识的推荐方案。总体而言,静脉溶栓指征不受基线神经功能缺损程度限制,大面积脑梗死患者应谨慎评估溶栓风险;急诊血管内介入治疗可改善前后循环大动脉闭塞患者预后,但对于超大面积梗死患者,应积极防治脑水肿等并发症。对于接受再灌注治疗的患者,血压控制应与血管再通情况相结合,维持较平稳的血压水平。

Severe ischemic stroke is characterized by severe neurological deficits,sometimes accompanied by cardiovascular and respiratory dysfunction,which could lead to severe disability and death.This article reviews the national and international trials of reperfusion treatment for severe ischemic stroke in recent 20 years,and summarizes relevant clinical guidelines and expert consensus.In general,intravenous thrombolysis is not restricted for patients with severe neurological deficits,but should be cautiously considered for patients with large infarction.Patients with large vessel occlusion could benefit from endovascular treatment,and whilst prevention and treatment for brain edema are important for patients with very large infarction.For patients who have received reperfusion therapies,the target for the management of blood pressure should incorporate the status of recanalization and a stable level of blood pressure should be maintained.