蛛网膜下腔出血最新指引推荐2013翻译VIP专享VIP免费

MedicalMeasurestoPreventRebleedingAfteraSAH:Recommendations动脉瘤性蛛网膜下腔出血（aSAH）后预防再出血的药物推荐：1.BetweenthetimeofaSAHsymptomonsetandaneurysmobliteration,bloodpressureshouldbecontrolledwithatitratableagenttobalancetheriskofstroke,hypertension-relatedrebleeding,andmaintenanceofcerebralperfusionpressure(ClassI;LevelofEvidenceB).(Newrecommendation)1、aSAH症状出现到动脉瘤处理后这段时间里，应使用容易调控的药物将血压在一定的水平，使卒中风险与高血压相关的再出血风险达到平衡，并保证足够的脑血管灌注压。（I级推荐，B级证据）（新的推荐）2.Themagnitudeofbloodpressurecontroltoreducetheriskofrebleedinghasnotbeenestablished,butadecreaseinsystolicbloodpressureto<160mmHgisreasonable(ClassIIa;LevelofEvidenceC).(Newrecommendation)2、降低再出血风险应将血压降到什么程度尚没有定论，但是收缩压降至160mmHg以下是合理的。（IIa级推荐，C级证据）（新的推荐）3.Forpatientswithanunavoidabledelayinobliterationofaneurysm,asignificantriskofrebleeding,andnocompellingmedicalcontraindications,shortterm(<72hours)therapywithtranexamicacidoraminocaproicacidisreasonabletoreducetheriskofearlyaneurysmrebleeding(ClassIIa;LevelofEvidenceB).(Revisedrecommendationfrompreviousguidelines)3、如果患者因各种原因无法及时行动脉瘤阻断治疗，再出血风险大而没有明显药物禁忌症的情况下，短期应用(<72小时)氨甲环酸或氨基己酸来降低早期再出血风险是合理的（IIa级推荐，B级证据）（修改了旧指南的推荐）SurgicalandEndovascularMethodsofTreatmentofRupturedCerebralAneurysms:Recommendations破裂脑动脉瘤的外科和血管内治疗方法的推荐1.SurgicalclippingorendovascularcoilingoftherupturedaneurysmshouldbeperformedasearlyasfeasibleinthemajorityofpatientstoreducetherateofrebleedingafteraSAH(ClassI;LevelofEvidenceB).1、对大部分患者而言，破裂动脉的外科夹闭或血管内栓塞应尽早进行以降低再出血风险（I级推荐，B级证据）2.Completeobliterationoftheaneurysmisrecommendedwheneverpossible(ClassI;LevelofEvidenceB).2、推荐只要条件许可，任何时间都应完全阻塞动脉瘤。（I级推荐，B级证据）3.Determinationofaneurysmtreatment,asjudgedbybothexperiencedcerebrovascularsurgeonsandendovascularspecialists,shouldbeamultidisciplinarydecisionbasedoncharacteristicsofthepatientandtheaneurysm(ClassI;LevelofEvidenceC).(Revisedrecommendationfrompreviousguidelines)3、动脉瘤的治疗应由多科会诊讨论（如有经验的脑血管外科和血管内专家进行讨论），根据患者和动脉瘤的特点决定治疗方案。（I级推荐，C级证据）（与之间的指南相比进行了修改）4.Forpatientswithrupturedaneurysmsjudgedtobetechnicallyamenabletobothendovascularcoilingandneurosurgicalclipping,endovascularcoilingshouldbeconsidered(ClassI;LevelofEvidenceB).(Revisedrecommendationfrompreviousguidelines)4、对于动脉瘤破裂的患者，如果讨论后认为既可以做血管内栓塞也可以做外科夹闭，那么应考虑血管内栓塞（I级推荐，B级证据）5.Intheabsenceofacompellingcontraindication,patientswhoundergocoilingorclippingofarupturedaneurysmshouldhavedelayedfollow-upvascularimaging(timingandmodalitytobeindividualized),andstrongconsiderationshouldbegiventoretreatment,eitherbyrepeatcoilingormicrosurgicalclipping,ifthereisaclinicallysignificant(eg,growing)remnant(ClassI;LevelofEvidenceB).(Newrecommendation)5、没有明确的禁忌症，破裂动脉瘤栓塞或夹闭术后的患者应在术后进行造影复查（时间和方式可以个体化选择）。如果复查发现临床症状明显的残留血管瘤，强烈推荐再次进行治疗，再次进行栓塞或进行夹闭小手术。（I级推荐，B级证据）（新的推荐）6.Microsurgicalclippingmayreceiveincreasedconsideratio...