2018版《加拿大脑卒中最佳实践共识声明:妊娠期急性脑卒中管理》解读

Comments on 2018 Canadian Stroke Best Practice Consensus Statement:Acute Stroke Management during Pregnancy

鉴于目前对妊娠期及产褥期急性脑卒中人群缺乏系统性研究资料,临床医师往往根据自己的经验处理此类患者以致诊治欠规范,不能有效地维护母婴健康。2018年加拿大心脏和脑卒中基金会(Heart and Stroke Foundation of Canada,HSFC)联合加拿大脑卒中联盟(Canadian Stroke Consortium,CSC)发布了2018版《加拿大脑卒中最佳实践共识声明:妊娠期急性脑卒中管理》,该共识声明由脑卒中医学专家和母胎医学专家合作制定,涉及妊娠期及产褥期脑卒中的初步急诊管理、影像学诊断、急性脑卒中治疗、出血性脑卒中管理、麻醉管理、妊娠期脑卒中管理(产前、产时及产后)以及脑卒中后二级预防及康复,其证据主要来源于非妊娠期脑卒中或妊娠同期组群研究。由于妊娠是几乎所有急性脑卒中临床试验的排除标准,且妊娠期脑卒中事件相对少见,因此缺乏来源于随机对照试验的高质量证据,所以该共识声明还使用了基于病例报告、病例系列报告以及以人口为基础的登记研究的数据。该共识声明的推荐反映了基于专业和临床经验的专家意见。

Due to the lack of systematic research data on acute stroke in the pregnant and postpartum population currently, the clinicians always treat those patients according to their own experience. This situation has led to non-standard treatment and could not effectively protect the health of mothers and infants. In 2018, the Heart and Stroke Foundation of Canada(HSFC)combined with Canadian Stroke Consortium(CSC) published 2018 Canadian Stroke Best Practice Consensus Statement: Acute Stroke Management during Pregnancy. This consensus statement was developed by interdisciplinary cooperation between stroke experts andmaternal-fetal experts, covering initial emergency management, imaging diagnosis, acute stroke treatment, hemorrhagic stroke management, anesthesia management, management in the gestational(prenatal, intrapartum and postpartum) stroke population, and secondary prevention and post-stroke rehabilitation. The evidence was primarily derived from studies of non-pregnant stroke or synchronous pregnancy groups. Pregnancy has been the exclusion criteria for almost all acute stroke trials and the cases of pregnant stroke are relatively rare,the high-quality evidence from randomized controlled trials is insufficient. Accordingly,this consensus statement used the data as evidence obtained by case reports, case series reports, and population-based registration studies. The recommendations of this consensus statement reflected expert opinions based on professional and clinical experience.