脑出血指南知识讲座培训课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,脑出血指南知识讲座,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,脑出血指南知识讲座,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,脑出血指南知识讲座,脑出血指南知识讲座,脑出血指南知识讲座,A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association给予来自美国心脏协会/美国卒中协会的卫生保健专业人员的指南,脑出血指南知识讲座,2,A Guideline for Healthcare Pro,一、Emergency Diagnosis and Assessment of ICH,and Its Causes Recommendations,关于脑出血的紧急诊断和评估的建议,脑出血指南知识讲座,3,一、Emergency Diagnosis and Asse,1.Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke,p1,from ICH,p2,(Class I;Level of Evidence:A).(Unchanged from the previous guideline),CT或MRI（核磁共振成像）的快速成像便于很好地区分缺血性中风和脑出血（出血性脑中风）。（与先前的指南并无差异）,脑出血指南知识讲座,4,1.Rapid neuroimaging with CT,2.CT angiography and contrast-enhanced CT,p3,may be considered to help identify patients at risk for hematoma expansion(Class IIb;Level of Evidence:B),CT血管造影术和强化CT或许可以辅助鉴别有血肿扩散危险的病人,and CT angiography,CT venography,contrast-enhanced CT,contrast-enhanced MRI,magnetic resonance angiography,and magnetic resonance venography can be useful to evaluate for underlying structural lesions,including vascular malformations and tumors when there is clinical or radiological suspicion(Class IIa;Level of Evidence:B).(New recommendation),同时，CT血管造影术、CT静脉造影术、加强CT、加强MRI（核磁共振）、磁共振血管造影、磁共振静脉造影，可以检查到潜在的结构损伤，包括临床上或放射学上怀疑的血管畸形和肿瘤。（新推荐）,脑出血指南知识讲座,5,2.CT angiography and contrast,二、Medical Treatment for ICH Recommendations,关于脑出血内科治疗的建议,p4,脑出血指南知识讲座,6,二、Medical Treatment for ICH Re,1.Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets,respectively(Class I;Level of Evidence:C).(New recommendation),严重缺乏凝血因子或者说有严重血小板减少症的病人，应该适当地接受外来因子或者血小板来进行治疗。（新推荐）,脑出血指南知识讲座,7,1.Patients with a severe coag,2.Patients with ICH whose INR,p5,is elevated due to OACs,p6,should have their warfarin withheld,receive therapy to replace vitamin Kdependent factors and correct the INR,and receive intravenous vitamin K(Class I;Level of Evidence:C).,对于那些由口服抗凝剂OACs,p7,导致INR（国际标准化比值）升高的脑出血病人，不应该再用华法令，而该接受上述治疗来取代维生素K依赖性因子，同时，该改善INR水平、接受静脉内维生素K治疗。,PCCs,p8,血浆凝固剂have not shown improved outcome compared with新鲜冷冻血浆 FFP,p9,but may have fewer complications compared with FFP and are reasonable to consider as an alternative to FFP(Class IIa;Level of Evidence:B).,与新鲜血浆相比，血液凝固剂并没有显示出明显改善的治疗成果，但是可能并发症更少，是值得考虑的新鲜血浆替代物。,脑出血指南知识讲座,8,2.Patients with ICH whose INR,rFVIIa,p10,does not replace all clotting factors,and although the INR may be lowered,clotting may not be restored in vivo;therefore,rFVIIa is not routinely recommended as a sole agent for OAC reversal in ICH(Class III;Level of Evidence:C).(Revised,from the previous guideline).,重组凝血因子VII并不能替代所有的凝结因子；虽然INR可能会被降低，但是体内的血凝块并不能消除。所以，并不推荐把rFvlla作为脑出血病人OAC逆转的唯一药剂。（由先前指南修订）,脑出血指南知识讲座,9,rFVIIap10 does not replace a,3.Although rFVIIa can limit the extent of hematoma expansion in noncoagulopathic ICH patients,thereis an increase in thromboembolic risk with rFVIIa and no clear clinical benefit in unselected patients.Thus rFVIIa is not recommended in unselected patients.(Class III;Level of Evidence:A).(New recommendation)Further research to determine whether any selected group of patients may benefitfrom this therapy is needed before any recommendation for its use can be made.,虽然重组凝血因子VII可以限制非凝血异常性脑出血病人血肿扩大，但是应用rFVlla 时发生血栓的危险性却增加了，同时，对于随机选定的患者没有明显的临床利益。（新推荐）在可以得出有关其应用的任何推荐之前，需要做更深层次的研究来验证是否任何被选定的病人群体都可以从这种治疗获益。,脑出血指南知识讲座,10,3.Although rFVIIa can limit t,4.The usefulness of platelet transfusions in ICH patients with a history of antiplatelet use is unclear and is considered investigational(Class IIb;Level of Evidence:B).(New recommend),对于有抗血小板治疗病史的脑出血病人，给予输液血小板治疗的有效性并不清楚、有待于研究。（新推荐）,5.Patients with ICH should have intermittent pneumatic compression,p11,for prevention of venous thromboembolism in addition to elastic stockings,p12,(Class I;Level of Evidence:B).(Unchanged from the previousguideline),为了预防脑出血病人出现下肢静脉栓塞,p13,，除了下肢要穿弹力袜子、也要进行间歇性的充气压迫治疗（与先前的指南并无差异）,脑出血指南知识讲座,11,4.The usefulness of platelet,6.After documentation of cessation of bleeding,lowdose subcutaneous low-molecular-weight heparin or unfractionated heparin may be considered for prevention of venous thromboembolism in patients with lack of mobility after 1 to 4 days from onset(ClassIIb;Level of Evidence:B).(Revised from the previousguideline),在确定病人出血停止后，皮下注射低剂量的低分子量的肝素或者肝素，可能用于防止病人发病后1到4天后发生静脉栓塞。（由先前指南修订）,脑出血指南知识讲座,12,6.After documentation of cess,三、,Blood Pressure Recommendations（有关血压方面的建议）,1.Until ongoing clinical trials of BP intervention for ICH are completed,physicians must manage BP on the basis of the present incomplete efficacy evidence.Current suggested recommendations for target BP in various situations are listed in Table 6 and may be considered(Class IIb;Level of Evidence:C).(Unchangedfrom the previous guideline),在正在进行的脑出血病人血压干预临床试验完成之前，医师必须依据目前不完善的循证医学证据的基础，来适当控制血压。目前，对于不同情况下所推荐的血压处理方法，请见表6，值得借鉴。（与先前的指南并无差异）,脑出血指南知识讲座,13,三、B