Новые рекомендации по лечению инсульта

[Gilarov]

18 апреля в Stroke опубликованы [Ссылки доступны только зарегистрированным пользователям ] по лечению ишемического инсульта
Доступ свободный.
Как и раньше...

Class III Recommendation

1. At present, no intervention with putative neuroprotective

actions has been established as effective in improving

outcomes after stroke, and therefore none currently

can be recommended (Class III, Level of Evidence A).

This recommendation has not changed from previous guidelines.

[Rodionov]

Так и неясным осталось, насколько активно надо снижать АД.

The management of arterial hypertension remains controversial. Data to guide recommendations for treatment are inconclusive or conflicting. Many patients
have spontaneous declines in blood pressure during the first 24 hours after onset of stroke. Until more definitive data are available, it is generally agreed that a cautious approach to the treatment of arterial hypertension should be recommended (Class I, Level of Evidence C). Patients who have other medical indications for aggressive treatment of blood pressure should be treated. This recommendation has not changed from previous statements.

6. Patients who have elevated blood pressure and are otherwise eligible for treatment of rtPA may have their blood pressure lowered so that their systolic
blood pressure is <185 mm Hg and their diastolic blood pressure is <110 mm Hg (Class I, Level of Evidence B) before lytic therapy is started. This recommendation has not changed from previous statements. If medications are given to lower blood pressure, the clinician should be sure that the blood
pressure is stabilized at the lower level before treating with rtPA and maintained below 180/105 mm Hg for at least the first 24 hours after intravenous rtPA treatment. Because the maximum interval from stroke onset until treatment with rtPA is short, many patients with sustained hypertension above recommended levels cannot be treated with intravenous rtPA.

[Igor73]

Сообщение от Rodionov

Так и неясным осталось, насколько активно надо снижать АД.

Есть идея смотреть ультразвуком интракраниальный кровоток. До определённого уровня АД он будет компенсированным, при снижении АД ниже некоего индивидуального порога - декомпенсированным.
1. P J Eames, M J Blake, S L Dawson, R B Panerai, J F Potter "Dynamic cerebral autoregulation and beat to beat blood pressure control are impaired in acute ischaemic stroke" J Neurol Neurosurg Psychiatry 2002;72:467–473
2.Brian J. Carey, MRCPI; Bradley N. Manktelow, MSc; Ronney B. Panerai, PhD; John F. Potter, DM "Cerebral Autoregulatory Responses to Head-Up Tilt in Normal Subjects and Patients With Recurrent Vasovagal Syncope" Circulation. 2001;104:898-902.

[Dr.Vad]

Сообщение от Igor73

Есть идея смотреть ультразвуком интракраниальный кровоток.

Есть идея покруче: ультразвуком улучшать тромболизис (работы Александрова АВ, напр.):

Alexandrov AV.
Therapeutic applications of transcranial ultrasound devices.
Expert Rev Med Devices. 2007 Jan;4(1):1-3

Alexandrov AV, Molina CA, Grotta JC, Garami Z, Ford SR, Alvarez-Sabin J, Montaner J, Saqqur M, Demchuk AM, Moye LA, Hill MD, Wojner AW; CLOTBUST Investigators.
Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke.
N Engl J Med. 2004 Nov 18;351(21):2170-8

[Ссылки доступны только зарегистрированным пользователям ]