醒后卒中患者接受再灌注治疗的选择模式

脑血管病是严重危害人类健康和生命的常见病、多发病,其发病率、病死率、致残率及再发率均高,随着社会人口的老龄化加剧,脑血管病的危害在逐渐上升。虽然静脉使用阿替普酶及血管内治疗的有效性已被证实,但只有少数患者接受了这种治疗。低治疗率很大一部分原因是因发病时间不能确定或就诊时间的延误造成的。醒后卒中患者因发病时间无法界定,因而无法行再灌注治疗。随着一些重要研究的开展及成功,使我们重新思考简单按时序表达的“时间窗”概念,认识到即使在超过指南推荐的时间窗,仍有可能存在可挽救有梗死风险的脑组织,逐渐形成了“组织窗”的治疗理念。这一转变,离不开先进影像学技术的发展和应用,这项技术的发展,使得临床医师可以根据临床评估及影像成像来判断患者的发病时间和可挽救组织的存在,可能会使更多的卒中患者获得再灌注治疗的益处。目前,已有多项研究试图通过影像学和临床评估相结合的方法来判断患者的发病时间和寻找缺血半暗带存在的证据。在这篇综述中,将探讨目前接受再灌注治疗的醒后卒中患者的选择模式。

The choice mode of reperfusion treatment for patients with wake-up stroke

Cerebrovascular disease is a common and frequently occurring disease that seriously endangers human health and life.Its morbidity,mortality,disability rate and recurrence rate are all high.With the aging of the social population,the harm of cerebrovascular disease is gradually increasing.Although the efficacy of intravenous ateplase and intravascular treatment has been confirmed,only a few patients have received this treatment.A large part of the reason for such a low treatment rate is due to the uncertainty of the onset time or the late present,which makes a considerable number of patients not qualified for reperfusion treatment.Since the onset time of wake-up stroke cannot be defined,it is impossible to perform reperfusion treatment.With the development and success of some important researches,we rethink the concept of"time window"which is simply expressed in time sequence.We realize that even if the time window recommended by the guide is exceeded,there may still be salvageable brain tissue with infarction risk,and gradually form the treatment concept of"tissue window".This change can not be separated from the development and application of advanced imaging technology.The development of this technology enables clinicians to judge the onset time of patients and the existence of salvageable tissue according to clinical evaluation and imaging,which may enable more stroke patients to obtain the benefits of reinjection treatment.At present,there are many studies trying to judge the onset time of patients and find the evidence of ischemicc penumbra by imaging and clinical evaluation.In this review,we will explore the current selection model of patients with wake-up stroke receiving reperfusion treatment.