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细数20年间卒中二级预防进展历程

时间:2017-05-31 01:29来源:火把 作者:beryl 点击:

作者:Ha new goods-Christoph Diener(埃森大学神经学系)

在昔时的20年中,听说con彩民高手论坛。卒中的二级防止都有哪些强大变化?本文将针对20年间卒中的二级防止起色举办总结。听说有钱人高手论坛。

卒中二级防止的抗血栓调整

让我们首先从抗血小板疗法来举办接洽。毫无疑问的是,有钱人高手论坛。阿司匹林对付卒中的二级防止是有用的,对于有钱人高手论坛。但是风险的下降水平很不彰着。二级。现在,中二。氯吡格雷单药疗法的效果并不优于阿司匹林[1].它具有爆发出血并发症的细轻风险。阿司匹林安静释双嘧达莫的组合效果优于阿司匹林[2].但是在永恒调整方面,有钱人高手论坛。阿司匹林与氯吡格雷连结用药并不优于阿司匹林单药或氯吡格雷单药,你看进展。并且会带来更高的出血风险[3.4].现时,我们想要找出阿司匹林与氯吡格雷连结用药在短期防止卒中复发方面能否优于阿司匹林(即在第4-12周卒中后)。

这一题目的紧要冲破是新型口服抗凝药对房颤患者的卒中二级防止[5].总的来说,这些药物与华法林相比,你知道有钱人高手论坛。将会下降大约15%的卒中复发风险,听听细数。下降15%的仙逝率,并下降10%&mdlung burning whilsth;&mdlung burning whilsth;15%的强大出血事情,最重要的是会下降55%的颅内出血风险。

症状性颈动脉及颅内动脉狭隘的调整起色

另一个题目是症状性颈动脉狭隘。con彩民高手论坛。这些患者可从颈动脉手术或支架置入术中获益。将全数的证据聚在一起后展现,手术很能够优于支架置入术,听说有钱人高.手论坛。奇特是在75岁以上的患者及女性患者中。倒霉的是,最近并没相关于对照最佳药物调整与介入调整的实习。事实上细数20年间卒中二级预防进展历程。不过,你看高手论坛开奖结果。我们现在有来自两个随机对照实习的清楚证据,听说细数20年间卒中二级预防进展历程。证明颅内动脉狭隘支架成形术并不优于最佳药物调整[6.7].

限制二次卒中的风险身分

在风险身分限制方面,我们有清楚的证据注明,抗高血压调整,年间。奇特是血管严重素转换酶禁止剂(ACEI)和血管严重素受体拮抗剂(ARB),将省略二次卒中的风险[8.9].现时的降压主意是低于140/90mmHg.糖尿病患者低于130/90mmHg.我们也有证据注明,预防。阿托伐他汀可以下降卒中的风险,看着历程。且并不补充脑出血风险,非论胆固醇能否降低[10].

对付糖尿病的卒中二级防止,我们惟有阳性实习到底;无论是新的抗糖尿病药物还是主动或不主动的血糖限制都是如此[11.12].看来,对于大红鹰高手心水论坛一。纵使主动降糖调整也会补充血管事情风险,看着香港有钱人心水论坛。而不是省略风险。学习有钱人高手论坛。此外,倘若糖尿病调整太主动,这能够招致调整惹起的多发性神经病。高手论坛开奖结果。

我们有其他风险身分的证据,但是实在没有随机实习在研究戒烟、省略酒精、加重体重、补充膂力活动,奇特是卒中二级防止饮食的作用。现在我们有越来越多的证据,至多有一些较小的实习,被称为分析疗法(即最佳药物调整),其中包括行为危险身分的解决,如戒烟、膂力活动及认知锻炼,不只可以下降卒中的风险,而且还可以下降认知才略下降的风险。

总结思念

防止卒中,我们可以做很多事情,但最重要的题目是,我们必需落实这些防止战术,并且要解决我们的患者对药物调整的允从性和合规性。20年前,我们对卒及第办防止的独一方法是阿司匹林。现在,我们一经有了更多调整方式来应对卒中患者的不同亚群,无论是大血管病和心源性卒中。

昔时20年以来,防止卒中的做事行之有用,但我们必需从这里起先不停走一条冗长的路。

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编译自:Ha new goods-Christoph Diener. 20 Years of Progress in Secondary Stroke Prevention. Medscape.

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