1. 2012 01 09
賴彥安 藥師 整理
Stroke published online July 22, 2010

3. + 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

5. + 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

6. + 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.

7. + 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

8. + 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

9. + 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

10. + 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

12. + 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

13. + 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