{"id":63861,"date":"2018-10-17T01:00:00","date_gmt":"2018-12-07T03:32:24","guid":{"rendered":"http:\/\/www.05921.net\/index.php\/2018\/12\/07\/4ac021b813\/"},"modified":"2018-12-07T11:32:27","modified_gmt":"2018-12-07T03:32:27","slug":"4ac021b813","status":"publish","type":"post","link":"https:\/\/www.05921.net\/index.php\/63861\/","title":{"rendered":"\u8111\u51fa\u8840\u6025\u6027\u671f\uff0c\u8840\u538b\u8d8a\u4f4e\u8d8a\u597d\uff1f"},"content":{"rendered":"
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\u8111\u51fa\u8840\u7684\u6025\u6027\u671f\u4e00\u822c\u6307\u53d1\u75c5\u540e 2 \u5468\u4ee5\u5185\uff0c\u4e3b\u8981\u6cbb\u7597\u76ee\u6807\u662f\u7a33\u5b9a\u751f\u547d\u4f53\u5f81\u3001\u633d\u6551\u751f\u547d\u548c\u51cf\u5c11\u5e76\u53d1\u75c7\u3002\u5bf9\u4e8e\u8111\u51fa\u8840\u6025\u6027\u671f\u964d\u8840\u538b\u7684\u6cbb\u7597\uff0c\u5176\u83b7\u76ca\u53ca\u98ce\u9669\u4e00\u76f4\u662f\u5b58\u5728\u4e89\u8bba\u7684\u3002<\/p>\n


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\u770b\u770b\u6307\u5357\u662f\u600e\u4e48\u8bf4<\/strong><\/strong><\/p>\n<\/section>\n

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\u8868 1. \u9ad8\u8840\u538b\u6027\u8111\u51fa\u8840\u7684\u6307\u5357<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

\"\u8111\u51fa\u8840\u6025\u6027\u671f\uff0c\u8840\u538b\u8d8a\u4f4e\u8d8a\u597d\uff1f\"
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\u6025\u6027\u671f\u964d\u538b\u53ef\u80fd\u7684\u300c\u95ee\u9898\u300d<\/strong><\/p>\n<\/section>\n

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\u56fd\u5185\u5916\u6307\u5357\u5bf9\u4e8e\u9ad8\u8840\u538b\u6027\u8111\u51fa\u8840\u6025\u6027\u671f\u964d\u538b\u7684\u542f\u52a8\u65f6\u673a\u548c\u8840\u538b\u76ee\u6807\u7684\u63a8\u8350\u5e76\u4e0d\u4e00\u81f4\uff0c\u4e5f\u53cd\u6620\u51fa\u6211\u4eec\u4e34\u5e8a\u5de5\u4f5c\u4e2d\u7684\u56f0\u60d1\u3002\u4f46\u6559\u6761\u5f0f\u5730\u5bf9\u6240\u6709\u8111\u51fa\u8840\u60a3\u8005\u4e0d\u52a0\u9009\u62e9\u3001\u6ca1\u6709\u8282\u5236\u7684\u964d\u538b\uff0c\u53ef\u80fd\u9690\u85cf\u7740\u98ce\u9669\u3002<\/p>\n

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 \u5f3a\u5316\u964d\u538b\u4e0d\u4e00\u5b9a\u5c31\u80fd\u9650\u5236\u8840\u80bf\u6269\u5927 <\/strong><\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u65e9\u671f\u7684\u7814\u7a76\u8ba4\u4e3a\u6536\u7f29\u538b\u589e\u9ad8\u662f\u8840\u80bf\u6269\u5927\u7684\u72ec\u7acb\u9884\u6d4b\u56e0\u5b50\uff0c\u964d\u538b\u6cbb\u7597\u542f\u52a8\u8d8a\u65e9\u8d8a\u80fd\u6709\u6548\u5730\u9650\u5236\u8840\u80bf\u6269\u5927\u3002\u4f46 Interact2 \u7684\u7ed3\u679c\u5e76\u4e0d\u652f\u6301\u8fd9\u4e00\u8bf4\u6cd5\u3002<\/p>\n


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\"\u8111\u51fa\u8840\u6025\u6027\u671f\uff0c\u8840\u538b\u8d8a\u4f4e\u8d8a\u597d\uff1f\"<\/p>\n


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964 \u4f8b\u60a3\u8005\u5728 24 h \u540e\u590d\u67e5\u4e86\u5934\u9885 CT\uff0c\u5f3a\u5316\u964d\u538b\u7ec4\u548c\u6807\u51c6\u964d\u538b\u7ec4\u8840\u80bf\u4f53\u79ef\u6269\u5927\u7684\u76f8\u5bf9\u5dee\u5f02\u4e3a 4.5%\uff0c\u7edd\u5bf9\u5dee\u5f02\u4e3a 1.4 ml\uff0c\u5747\u65e0\u7edf\u8ba1\u5b66\u5dee\u5f02\u3002<\/p>\n


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\u6b64\u5916 ATACH2 \u7814\u7a76\u663e\u793a\uff0c\u5bf9\u5b58\u5728\u8840\u80bf\u6269\u5927\u98ce\u9669\u7684\u60a3\u8005\u8fdb\u884c\u5f3a\u5316\u964d\u538b\u6cbb\u7597\u540e\uff0c\u5e76\u4e0d\u80fd\u9650\u5236\u8840\u80bf\u7684\u6269\u5927\uff0c\u66f4\u4e3a\u53ef\u60dc\u7684\u662f\uff0c\u540c\u6837\u4e5f\u4e0d\u80fd\u6539\u5584\u60a3\u8005\u4e34\u5e8a\u7ed3\u5c40\u3002<\/p>\n


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\u56e0\u6b64\u5f3a\u5316\u964d\u538b\u5e76\u4e0d\u80fd\u9650\u5236\u8840\u80bf\u7684\u6269\u5927\uff0c\u4e5f\u53ef\u80fd\u5e26\u4e0d\u6765\u989d\u5916\u7684\u4e34\u5e8a\u83b7\u76ca\u3002<\/p>\n

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 \u5f3a\u5316\u964d\u538b\u589e\u52a0\u51fa\u8840\u540e\u6897\u6b7b\u98ce\u9669 <\/span><\/strong><\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u8bb8\u591a\u5b66\u8005\u5728\u8bba\u8bc1\u8111\u51fa\u8840\u540e\u6025\u6027\u671f\u964d\u538b\u7684\u5b89\u5168\u6027\u65f6\u4f1a\u4e3e\u51fa ICH-ADAPT \u7814\u7a76\u7684\u4f8b\u5b50\u3002\u8fd9\u9879\u75c5\u4f8b\u6570\u4e3a 75 \u7684\u7814\u7a76\u63d0\u793a\u5f3a\u5316\u964d\u538b\u5bf9\u704c\u6ce8\u538b\u548c\u8840\u80bf\u5468\u56f4\u6c34\u80bf\u65e0\u5f71\u54cd\u3002<\/p>\n


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\u540c\u65f6\u671f\u7684 DECIPHER \u7814\u7a76\u4e2d\uff0c\u5bf9 138 \u4f8b\u8111\u51fa\u8840\u60a3\u8005\u8fdb\u884c\u78c1\u5171\u632f\u626b\u63cf\uff0c\u7ed3\u679c\u53d1\u73b0\u65e9\u671f\u5e73\u5747\u52a8\u8109\u538b\u7684\u4e0b\u964d\u662f\u8111\u51fa\u8840\u540e\u6897\u6b7b\u7684\u72ec\u7acb\u5371\u9669\u56e0\u7d20\u3002\u7efc\u5408\u5404\u9879\u6587\u732e\u62a5\u9053\u62a5\u9053\u7684\u6570\u636e\uff0c\u8111\u51fa\u8840\u540e\u4f1a\u51fa\u8840\u540e\u6897\u6b7b\u7684\u53d1\u751f\u7387\u5927\u6982\u5728 11%-41%\u3002<\/p>\n


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\"\u8111\u51fa\u8840\u6025\u6027\u671f\uff0c\u8840\u538b\u8d8a\u4f4e\u8d8a\u597d\uff1f\"<\/p>\n


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ERICH \u7814\u7a76\u53d1\u73b0\uff0c\u5728 600 \u4f8b\u8111\u51fa\u8840\u60a3\u8005\u4e2d\uff0c26.5% \u53d1\u751f\u4e86\u51fa\u8840\u540e\u6897\u6b7b\uff1b\u60a3\u8005\u5165\u9662\u540e\u63a5\u53d7\u964d\u538b\u6cbb\u7597\u7684\u6bd4\u4f8b\uff0c\u51fa\u8840\u540e\u6897\u6b7b\u7ec4\u6bd4\u672a\u6897\u6b7b\u7ec4\u66f4\u9ad8\u3002<\/p>\n


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\u4ece\u529f\u80fd\u9884\u540e\u7684\u89d2\u5ea6\uff0c\u5165\u7ec4\u60a3\u8005 90 \u5929\u4e0d\u826f\u9884\u540e\uff08mRS 4-6\uff09\u7684\u53d1\u751f\u4e0e\u9662\u5185\u4f7f\u7528\u964d\u538b\u836f\u6709\u72ec\u7acb\u76f8\u5173\u6027\u3002\u56e0\u6b64\uff0c\u5ba2\u89c2\u6570\u636e\u8868\u660e\uff0c\u8111\u51fa\u8840\u540e\u8fc7\u5ea6\u964d\u538b\u4f1a\u5bfc\u81f4\u51fa\u8840\u540e\u6897\u6b7b\uff0c\u5bfc\u81f4\u4e0d\u826f\u529f\u80fd\u9884\u540e\u3002<\/p>\n

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 \u8fc7\u5feb\u8fc7\u5ea6\u964d\u538b\u589e\u52a0\u7ec4\u7ec7\u5668\u5b98\u4f4e\u704c\u6ce8\u5e76\u53d1\u75c7 <\/span><\/strong><\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

2015 ASA\/AHA \u6307\u5357\u5bf9\u4e8e\u964d\u538b\u6539\u5584\u529f\u80fd\u8f6c\u5f52\u7684\u8bc1\u636e\u4e3b\u8981\u6765\u6e90\u4e8e Interact 2 \u7814\u7a76\uff0c\u5f53\u65f6 ATACH 2 \u7684\u7ed3\u679c\u5c1a\u672a\u516c\u5e03\u3002
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\"\u8111\u51fa\u8840\u6025\u6027\u671f\uff0c\u8840\u538b\u8d8a\u4f4e\u8d8a\u597d\uff1f\"<\/p>\n


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\u4e0e Interact 2 \u4e00\u6837\uff0cATACH 2 \u5728\u4e3b\u8981\u7ec8\u70b9\u4e8b\u4ef6\u4e3a\uff1a90 \u5929\u7684\u6b7b\u4ea1\u6216\u8005\u91cd\u5927\u6b8b\u75be\u3002\u7ed3\u679c\u663e\u793a\uff0c\u5f3a\u5316\u964d\u538b\u7ec4\u4e0e\u6807\u51c6\u964d\u538b\u7ec4\u6ca1\u6709\u7edf\u8ba1\u5b66\u5dee\u5f02\uff0c\u800c\u4e14\u5f3a\u5316\u964d\u538b\u7ec4\u53ef\u589e\u52a0\u80be\u529f\u80fd\u969c\u788d\u53d1\u751f\u7387\u3002<\/p>\n


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\u4e3a\u4e86\u6392\u9664\u60a3\u8005\u4f9d\u4ece\u6027\u5bf9\u7ed3\u5c40\u7684\u5e72\u6270\uff0c2018 \u5e74\u7684 ATACH 2 \u56de\u987e\u6027\u5206\u6790\u7814\u7a76\uff0c\u5206\u6790\u4e86\u5b9e\u9645\u8840\u538b\u5bf9\u7ed3\u5c40\u7684\u5f71\u54cd\u3002\u7ed3\u679c\u63d0\u793a\u8840\u538b\u8fbe\u6807\u4e0d\u4ec5\u4e0d\u80fd\u964d\u4f4e\u8111\u51fa\u8840\u60a3\u8005\u7684\u6b7b\u4ea1\u7387\u6216\u8005\u4e25\u91cd\u6b8b\u75be\u7387\uff0c\u53cd\u800c\u589e\u52a0\u4e86\u795e\u7ecf\u529f\u80fd\u7684\u6076\u5316\u3001\u5fc3\u810f\u4e0d\u826f\u4e8b\u4ef6\u3001\u80be\u810f\u4e0d\u826f\u4e8b\u4ef6\u3002<\/p>\n


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SBP \u964d\u4f4e\u5e76\u7ef4\u6301\u7ec4\uff08SBP<140 mmHg \u6301\u7eed 21-22 \u4e2a\u5c0f\u65f6\uff09\u7684\u6b7b\u4ea1\u7387\u6216\u6b8b\u75be\u7387\u4e0e SBP \u672a\u8fbe\u6807\u7ec4\uff08SBP>140 mmHg\uff09\u76f8\u4f3c\u3002SBP \u8fbe\u6807\u7ec4 24 h \u5185\u795e\u7ecf\u529f\u80fd\u6076\u5316\u30017 \u5929\u5185\u5fc3\u810f\u76f8\u5173\u4e0d\u826f\u4e8b\u4ef6\u7684\u53d1\u751f\u7387\u660e\u663e\u9ad8\u4e8e SBP \u672a\u8fbe\u6807\u7ec4\u3002<\/p>\n

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 \u8840\u538b\u53d8\u5f02\u6027\u4e0e\u9884\u540e\u76f8\u5173 <\/span><\/strong><\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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Interact 2 \u7684\u56de\u987e\u6027\u5206\u6790\u63d0\u793a\uff1a\u6536\u7f29\u538b\u53d8\u5f02\u6027\u5728\u8111\u51fa\u8840\u540e\u8d85\u6025\u6027\u671f\u3001\u6025\u6027\u671f\u662f\u6b7b\u4ea1\u6216\u4e25\u91cd\u6b8b\u75be\u7684\u72ec\u7acb\u9884\u6d4b\u56e0\u5b50\uff1b\u5448\u7ebf\u6027\u76f8\u5173\uff0c\u8840\u538b\u53d8\u5f02\u6027\u8d8a\u5927\uff0c\u4e34\u5e8a\u9884\u540e\u8d8a\u5dee\u3002<\/p>\n


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\u65e5\u672c\u5b66\u8005\u7684 SAMURAI-IHC \u7ed3\u679c\u4e5f\u63d0\u793a\u8840\u538b\u53d8\u5f02\u6027\u4e0e 72 h \u795e\u7ecf\u529f\u80fd\u6076\u5316\u53ca 3 \u4e2a\u6708\u4e0d\u826f\u4e34\u5e8a\u7ed3\u5c40\u5bc6\u5207\u76f8\u5173\u3002<\/p>\n


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\"\u8111\u51fa\u8840\u6025\u6027\u671f\uff0c\u8840\u538b\u8d8a\u4f4e\u8d8a\u597d\uff1f\"<\/p>\n


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FAST-MAG \u7814\u7a76\u663e\u793a\uff0c\u53d1\u75c5\u540e 90 \u5929\uff0c\u8f83\u5927\u7684\u8840\u538b\u53d8\u5f02\u6027\u4e0e\u4e0d\u5229\u7684\u529f\u80fd\u9884\u540e\uff08\u6539\u826f Rankin \u8bc4\u5206 3\uff5e6 \u5206\uff09\u5177\u6709\u5f88\u5f3a\u7684\u5242\u91cf\u4f9d\u8d56\u6027\u5173\u8054\u3002<\/p>\n


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\u5176\u4e2d\uff0c\u8d85\u6025\u6027\u671f\u8840\u538b\u53d8\u5f02\u6027\u7684\u5f71\u54cd\u5c24\u5176\u660e\u663e\uff0c\u5373\u4f7f\u8c03\u6574\u4e86\u5e74\u9f84\u3001\u521d\u59cb\u4e25\u91cd\u7a0b\u5ea6\u548c\u5e73\u5747\u6536\u7f29\u538b\u4e4b\u540e\uff0c\u8d85\u6025\u6027\u671f\u8840\u538b\u53d8\u5f02\u6027\u6700\u9ad8\u7684\u524d 1\/5 \u60a3\u8005\u4e0d\u826f\u7ed3\u5c40\u98ce\u9669\u4e5f\u589e\u52a0\u4e86 3\uff5e4 \u500d\u3002<\/p>\n

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\u6700\u540e\uff0c\u5957\u7528\u6211\u56fd\u6307\u5357\u7684\u4e00\u6bb5\u8bdd<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\"\u8111\u51fa\u8840\u6025\u6027\u671f\uff0c\u8840\u538b\u8d8a\u4f4e\u8d8a\u597d\uff1f\"<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n
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\u65e9\u671f\u901a\u8fc7\u5e73\u7a33\u4e0e\u6301\u7eed\u5730\u63a7\u5236\u597d\u8840\u538b\uff0c\u7279\u522b\u662f\u89c4\u907f\u6536\u7f29\u538b\u7684\u5cf0\u503c\u53ef\u589e\u5f3a\u65e9\u671f\u79ef\u6781\u964d\u538b\u6cbb\u7597\u63aa\u65bd\u7684\u4e34\u5e8a\u83b7\u76ca\u3002\u8bf4\u660e\u8111\u51fa\u8840\u65e9\u671f\u5e73\u7a33\u7ba1\u7406\u8840\u538b\u7684\u91cd\u8981\u6027\u3002\u65e9\u671f\u79ef\u6781\u964d\u538b\u4ec5\u9650\u4e8e\u4e2a\u4f53\u5316\u8fdb\u884c\uff0c\u5c1a\u4e0d\u80fd\u5e38\u89c4\u666e\u904d\u4f7f\u7528\uff0c\u5e94\u4e25\u683c\u9009\u62e9\u5408\u9002\u7684\u60a3\u8005\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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\u4f5c\u8005\uff1a\u82cf\u5dde\u5927\u5b66\u9644\u5c5e\u7b2c\u4e00\u533b\u9662 \u65b9\u742a \u3001\u8463\u4e07\u5229\u3001\u5f90\u8011\u3001\u6731\u73cf\u534e\u3001\u9646\u6d77\u950b<\/p>\n


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3 \u5206\u949f\u5b66\u4f1a\u91cd\u75c7\u808c\u65e0\u529b\u5206\u578b<\/a>
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1. Gioia, L.C., et al., Ischemia in intracerebral hemorrhage is associated with leukoaraiosis and hematoma volume, not blood pressure reduction. Stroke, 2015. 46(6): p. 1541-7.<\/p>\n


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2. Kang, D.W., et al., New ischemic lesions coexisting with acute intracerebral hemorrhage. Neurology, 2012. 79(9): p. 848-55.<\/p>\n


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3. Kidwell, C.S., et al., Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage. Neurology, 2017. 88(8): p. 782-788.<\/p>\n


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4. Manning, L., et al., Blood pressure variability and outcome after acute intracerebral haemorrhage: a post-hoc analysis of INTERACT2, a randomised controlled trial. Lancet Neurol, 2014. 13(4): p. 364-73.<\/p>\n


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5. Tanaka, E., et al., Blood pressure variability on antihypertensive therapy in acute intracerebral hemorrhage: the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-intracerebral hemorrhage study. Stroke, 2014. 45(8): p. 2275-9.<\/p>\n


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6. Chung, P.W., et al., Association Between Hyperacute Stage Blood Pressure Variability and Outcome in Patients With Spontaneous Intracerebral Hemorrhage. Stroke, 2018. 49(2): p. 348-354.<\/p>\n


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7. Qureshi, A.I., et al., Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med, 2016. 375(11): p. 1033-43.<\/p>\n


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8. Qureshi, A.I., et al., Blood Pressure-Attained Analysis of ATACH 2 Trial. Stroke, 2018. 49(6): p. 1412-1418.<\/p>\n


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9. Rabinstein, A.A., Optimal Blood Pressure After Intracerebral Hemorrhage: Still a Moving Target. Stroke, 2018. 49(2): p. 275-276.<\/p>\n


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10. Anderson, C.S., et al., Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med, 2013. 368(25): p. 2355-65.<\/p>\n


<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section><\/div>\n","protected":false},"excerpt":{"rendered":"

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