摘要
醒后缺血性卒中(WUIS)又称觉醒型脑卒中,是指患者睡眠时无新发卒中症状,但在醒后患者本人或目击者发现其出现卒中表现的急性脑梗死患者.急性缺血性脑卒中治疗的关键是在时间窗内有效恢复再灌注.静脉注射重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗是目前公认有效治疗发病4.5h内急性缺血性脑卒中再灌注的首选方法.由于WUIS确切的发病时间不清楚,同时受目前科技水平的限制,静脉溶栓可能导致颅内出血风险增加,故2016年美国心脏协会联合美国卒中协会(AHA/ASA)在“静脉溶栓纳入排除标准科学声明”中不推荐对其行静脉溶栓治疗,本可能适合溶栓治疗的患者无法获得溶栓治疗,导致其临床预后较差.近年来,最新研究发现,基于多模式影像学检查指导醒后卒中患者静脉溶栓治疗安全、有效.多模式影像学检查有助于筛选急性再灌注疗法的患者,从而让一部分WUIS患者从急性再灌注治疗中获益.本文回顾总结近年来对WUIS的文献发现,WUIS和非WUIS患者的病理生理学变化、临床特征及影像学改变均大致相同,早期通过CT和MRI检查,有助于将急性卒中治疗方案扩展到WUIS患者.目前对于这类患者而言,在临床治疗策略的制定和实施中均有较大研究进展,本文就WUIS的研究进展和治疗现状进行简要综述.
Wake up ischemic stroke(WUIS),also known as awakening stroke,refers to patients with no new stroke symptoms during sleep,but after waking up,the patients or witness who found the acute cerebral infarction with stroke performance.The key to the treatment of acute ischemic stroke is to effectively restore reperfusion within the time window.The original intravenous recombinant tissue-type plasminogen activator(rt-PA)thrombolytic therapy,is widely recognized as an effective treatment method of choice for 4.5h onset of acute ischemic stroke reperfusion.Because the exact onset time of WUIS is unclear and limited by current scientific and technical levels,intravenous thrombolysis may lead to an increased risk of intracranial hemorrhage.Therefore,the American Heart Association and the American Stroke Association(AHA/ASA)were included in the M Intravenous ThrombolysisM.Intravenous thrombolysis is not recommended in the Standard Scientific Statement.Patients who may be suitable for thrombolytic therapy are not able to obtain thrombolytic therapy,resulting in poor clinical prognosis.In recent years,with the further development of relevant clinical research and the rapid development of imaging technology,the latest research found that multi-mode imaging examination is safe and effective for intravenous thrombolytic therapy in patients with post一stroke stroke.Multi-mode imaging studies help screening patients with acute reperfusion therapy,so that part of WUIS patients will benefit from the acute reperfusion therapy.This article reviews and summarizes the literature findings of WUIS in recent years.The pathophysiological changes,clinical features and imaging changes of patients with WUIS and non-WUIS are almost unanimously.Early CT and MRI examinations can help to extend acute stroke treatment to patients with WUIS.At present,for this type of patients,there are great research progress in the formula?tion and implementation of clinical treatment strategies.This article will briefly summarize the research progress and treatment status of WUIS.
作者
吴龙飞
鲁庆波
何晓琴
郭起峰
汪鸿浩
邓本强
Wu Longfet;Lu Qingbo;He Xiaoqin;Guo Qifen;Wang Honghao;Benqiang(Department of Neurology,the First People s Hospital of Kashgar Prefecture,Xinjiang 844000,China;Department of Rheumatism and Immunology f the First Peoples Hospital of Kashgar Prefecture,Xinjiang 844000,China;Department of Neurology,the 903rd Hospital of PLA,Hangzhou,Zhejiang 310013,China;Department of Neurology,Nanfang Hospital,Nanfang Medical University,Guangzhou,Guangdong 510515,China;Department of Neurology,Changhai Hospital,the Second Military Medical University,Shanghai 200433,China)
出处
《中国基层医药》
CAS
2020年第4期505-509,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
新疆维吾尔自治区科技支疆项目(2018E02099)
新疆维吾尔自治区喀什地区科学研究与技术开发计划项目(KS2O18O3O)。
关键词
卒中
血栓溶解疗法
磁共振成像
综述
Stroke
Thrombolytic therapy
Magnetic resonance imaging
Review
