Title: 5 ?????? ???? ????? ???? ????? ? CVA .
1????? ????????? ???? ?? ???? ?????? ??????
- ???? ?????? ??????
- ??? ?'
- ?"? ?'?? ???
- ?????? ?????? ?????, ????,
- ?? ?????
2???? ?????? ?????? ????? ?? ????? ????????? ????
- ??????
- ???? ????? ?????? ???? ????? ????.
- ???? ???? ???? 1 ????"?.
- ???? ???? ???? 2 ?????.
- 50 ?????? ?????? ?? ??? ?????????.
- 5 ?????? ???? ????? ???? ????? ? CVA .
- 15 ?????? ???? CVA ?? ???? ?? ???.
- 50 lt ?????? ????? ???? ?????? CVA/TIA
- 1 ??? 5 ??? ????? ? CVA ???? ??? 5 ????.
3Stroke Risk Factors
Nonmodifiable
Age, Gender, Race, Heredity
Modifiable
- Behaviors
- Cigarette smoking
- Heavy alcohol use
- Physical inactivity
- Medical Conditions
- Hypertension
- Cardiac disease
- Atrial fibrillation
- Hyperlipidemia
- Diabetes mellitus
- Carotid stenosis
- Prior TIA /stroke
4???? ?????? ?????? ????? ?? ????? ????????? ????
- ???? ?????
- ???? ?? 76 ???? ????"? ????????, ?????? ???????
????? ??? ??? ????? ?????? ?????????? ,??????. - ???? ??"? ,????? ?????? ?????.
- ?????? ????????? ?"? 140/90 ???? 64 ????, ?????
?? ???? ?????, ??? ?? 2/5 ,?????.
5???? ?????? ?????? ????? ?? ????? ????????? ????
- ?????? ??? ????? ?- 15 ???? ??????? ????"?
- ABC
- ?????? ??????, ????? ???, ??????, ?????? ??????
???? ?????? ?? ?? ????? ????. - ????? ??????? ?.?., ?????, ?????? ?????.
- ????? ???.
- ??"?.
- CT ??????? ??????.
6Ischemic Stroke
7???? ?????? ?????? ????? ?? ????? ????????? ????
- ????? ?????? ?????? ???? ??????
- ????? ????? ???????? ?????
- ???????? ????? ????? ???? ?"?
- ????? ???? ????????.
- ????? ?? ??? ?? ?????? ??????? ?????.
- ????? ?????? (NEUROPROTECTION ) ?"?
- ????? ?? ???????? ??? (CORE )
- ?????- ???????
- ????? ???????
8???? ?????? ?????? ????? ?? ????? ????????? ????
- ???????? ?????? ?????
- ??????? ????? ?? ??????? ??????.
- ??"? ?????? ??? ??????, ????? ???? ?????? .
- ??? ????? ???????.
9???? ?????? ?????? ????? ?? ????? ????????? ????
- ?? ?????? ?????? ????? ?? ?
- ??????? ???????? 160 ?? 300 ?"? ?? ???? , ????
?????? ????? ?????? ??? ????????? ??????. - ????? ?????? ???? ?????? DVT .
- ?? ?? ????? ?
- ????? ?????? ??? ?? LMW ????? ???????? ???????.
- ?????? ???????? ???? ????? ????? ???????? ???,
????????? ?? ??????? ???????, ???? ??? ???? ????,
??????? ?????? ?????????? ????? ??????.
10???? ?????? ?????? ????? ?? ????? ????????? ????
- ?????? ????
- ????????? ???? ????? ?? ???? ????.
- ??????? ???????, ????? ????? ?????? ???????.
- ????? ?????? ??? ?? ????? 1/5 ????? ????, ?????
??????. - ?????? ??????? ?"? 170/90 ???? 74 ????.
- ??"? ???? ??????.
11????? ????? ?????????? ?? ???? ???????? ???? ????
?????.
IV tPA - Acute Ischemic Stroke Inclusion
Criteria Age 18 through 79 years Clinical
diagnosis of ischemic stroke causing a
measurable neurological deficit. Reliably timed
onset of symptoms of ischemic stroke
within 3 hours of the time to initiation of
treatment with intravenous tPA.
12IV TPA ????? ???? ?????? ???????? ??? ???????
- ???????? ?????? ?? ?????, AVM, ????????, ?????
?????, ????? ???? ?? ???? ??????. - ?????????? ?????? ?? ?????.
- ?? ??? ?? ????? ????? ?? ?? ?????? ???? ?? ?????
- ?????? ??? ?????
- ??? ??? 80
- ?????? ????? ???? ????.
- ??????? ??????? ???????? ?- CT.
- ????????? ??????? ??????? ?? ????????
- ????? ? CT
- 50lt??????lt400 ?"?
- HCT gt25 gtPLT 100000
- ????? ?????? ?????
- ???? ?????? IV ?????? ?"? ???? ? 185/110
- ?????? ?????? ???? ?? ??????
- ??? ???????? ?????
- ???? ????, ???? ???? ???, ??????, ?????, ?? ?????
?????? ???????.
13???? ?????? ?????? ????? ?? ????? ????????? ????
- ?????? ????
- ????????? ???? ???? 5 ????
- ??????? ???????.
- ????? ??? ??????
- ??"? ??"?.
14???? ?????? ?????? ????? ?? ????? ????????? ????
- ???? ????? ?????????? ???? ?
- r-proUK ?????? ??? ????? ????? ???? ?????????
MCA - ??????
- ???? ???? ,??????, ????? ???????.
- ????? ?? ???? ?? ???????.
- ?????? ??????.
- ????? ???.
15(No Transcript)
16???? ?????? ?????? ????? ?? ????? ????????? ????
- ????? ??"? ????? ???? ?????? ??
- ????? ???? ??????? ???? ???? ????? ???????.
- ??????? ????? ????? ?????? ??"? ??????.
- ????? ?"? ?? ?????? ????? ??? ?????? ?? ????????
??????. - ?? ????? ???? ?????? ?????? ?"? ????? ???? ??????
?? !!!!
17???? ?????? ?????? ????? ?? ????? ????????? ????
- ????? ??"? ????? ???? ?? ??? ??????????
- ??????? 220 ?? ???????? gt 120. ????? ????, ???
?? ?? ????? ????? ????. ????? ??????? ????? ?????
?????????? ?????? ???, ????, ?? ???. - ??????? lt 220 ?? ???????? gt 121-140????? ???????
10-20 ?"? IV ????? ??????. - ???????? lt 140 ??????????? IV ?????? ?? 0.5
???/?"?/???. - ???? ??????, ????? ?? 10-15 ????? ?"?.
18???? ?????? ?????? ????? ?? ????? ????????? ????
- ????? ??"? ????? ???? ?? ?? ??????????
- ???? ????? ??????????
??????? lt 185 ?? ???????? lt110 ,?????
???????? 10-20 ?"? IV ????? ?????? - ????? ????? ????? ??????????
- ????? ?????
- ???????? lt 140 ,???????????.
- ??????? lt 230 ?? ???????? gt 121-140, ?????
??????? 10-20 ?"? IV ????? ??????. - ??????? lt 180-230 ?? ???????? 121-140?????
??????? 10-20 ?"? IV ????? ??????.
19???? ?????? ?????? ????? ?? ????? ????????? ????
- ?????? ?????? ?????? ????"?
- ????? ????????.
- ????? ??????????.
- ????? ??????.
- ????? ????? ?? ???? ???? ???.
- ????? ??????? ??????????.
- ????? ???????.
20???? ?????? ?????? ????? ?? ????? ????????? ????
- ???? ???? ????? ?????
- ?? 65 ??"?, ?? ????? , ???????? ?? ??????? ?????
??????. - ???? ????"?.
- ??? ?????? ??????? ?? ?????? ?? ??? ??? ?? ??????
????? ??????. ???? ??? ?????? ?????. - ??????? ?"? 220/130, ???? ?????, ????? ?? ??? ???
???? ?????.
21???? ?????? ?????? ????? ?? ????? ????????? ????
- ?????? ??????? ?????? ???? ???? ????
- ABC
- ???? ???? ??????????.
- ?????? ?????? ?????????.
- ?????
- ??"?
- ????? ???
- CT ???
22Intracerebral Hemorrhage
23 Subarachnoid Hemorrhage
24???? ?????? ?????? ????? ?? ????? ????????? ????
- ?????? ?????? ???? ??? ???? ICH
- GCS ?????????
- ???? ???????
- PULSE PRESSURE
- MABP
- ??? ???????
- ????? ??????
- ??? ????? ???????
- ???? ????? ???????
25???? ?????? ?????? ????? ?? ????? ????????? ????
- ????? ?????? ???? ??? ???? ICH
- ?????? ????? ????? ??????? ????? ??"?, ???????,
?????. - ????? ??? ????? ???? ????? ??? ??? ??????? ICP
???? ????????, ?????? ?????????, ????? ICP ,?????
???? ???, ??????. - ????? ????? ?? ??? ???????.
- ????? ?????????.
26???? ?????? ?????? ????? ?? ????? ????????? ????
- ?????
- ???? ???? ?????? , ???? ?????
- ????? ?????? ???????.
- ????? ?????? ???????.
- ????? ??? ????, ???? ??????
- ????? ????? ???????.
- ????? ??? ?????.
27???? ?????? ?????? ????? ?? ????? ????????? ????
- ????, ???? ???? "????? ???"
- ??? ???
- ???? ???????, ?? ????? ??? ??? ??????? ???? ???
- ?