ICH

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ICH

  1. 1. 2012 01 09賴彥安 藥師 整理 Stroke published online July 22, 2010
  2. 2. + 對ICH引起之Ischemic stroke建議快速地利用CT & MRI 去看神經影像來幫助診斷。 Level A+ 如Patient有凝血因子缺乏或是血小板低下時應接受 fator replacement或給予血小板治療。 Level C+ ICH patient 建議可施予間歇性氣壓治療(intermittent pneumatic compression)來預防thromboembolism, 此外也包含了彈性襪 Level B+ 如因服用OAC導致INR上升建議先停用wafarin並注射 給予vitamin-K Level C
  3. 3. + 一開始監測病患狀況時建議住在ICU並有專人護理師照護。 Level B+ 血糖要控制好 Level C+ 有癲癇症狀要適時給予抗癲癇藥物治療 Level A
  4. 4. + A randomized trial showing improved outcomes with tight glucose control (range 80 to 110 mg/dL) using insulin infusions in mainly surgical critical care patients.+ However, more recent studies have demonstrated increased incidence of systemic and cerebral hypoglycemic events and possibly even increased risk of mortality in patients treated with this regimen+ At present the optimal management of hyperglycemia in ICH and the target glucose remains to be clarified. Hypoglycemia should be avoided.
  5. 5. + Prophylactic anticonvulsant medication should not be used. Class III; Level of Evidence: B+ In prospective and population-based studies, clinical seizures have not been associated with worsened neurological outcome or mortality.+ patients who received antiepileptic drugs (primarily phenytoin) without a documented seizure were significantly more likely to be dead or disabled at 90 days
  6. 6. + 因ICH引起腦室阻塞(ventricular obstruction) 引起之水腦症(hydrocephalus)和/或腦幹壓迫 因盡速做手術將clot移除。 Level B+ 腦室引流(Ventricular drainage) as treatment for hydrocephalus is reasonable in patients with decreased level of consciousness. Class IIa; Level of Evidence: B
  7. 7. + 急性ICH血壓要控制好,尤其是那些Patient ICH是典型 的門脈高壓性血管病變(hypertensive vasculopathy)。 Level A
  8. 8. + In patients presenting with a systolic BP of 150 to 220 mm Hg, acute lowering of systolic BP to 140 mm Hg is probably safe. Class IIa; Level of Evidence: B+ After the acute ICH period, a goal target of a normal BP of <140/90 (<130/80 if diabetes or chronic kidney disease) is reasonable. Class IIa; Level of Evidence: B
  9. 9. + Intravenous mannitol is the treatment of choice to lower increased intracranial pressure, effectively lowering ICP and benefiting brain metabolism. It is administered as an initial bolus of 1 g/kg, followed by infusions of 0.25 to 0.5 g/kg every six hours.+ The goal of therapy is to achieve plasma hyperosmolality (300 to 310 mosmol/kg) while maintaining an adequate plasma volume; major side effects include hypovolemia and a hyperosmotic state
  10. 10. + 酒要避免 Class IIa; Level of Evidence: B+ 對有自發性腦葉(spontaneous lobar)的ICH病 患如要治療非瓣膜性心房纖維性顫動 (nonvalvular atrial fibrillation)不要長期地去 使用抗凝血藥物,會提高復發率。 Class IIa; Level of Evidence: B+ 出院後越早做復健越好 Class IIa; Level of Evidence: B

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