今年美國心臟協會及腦中風會協會共同發表了一篇新的臨床指引~~處理自發性腦出血~~
距離上一次的指引是在2007年，過了3年終於有新的指引出現，那就看看有啥不同處吧!!一樣是依照證據等級及推薦等級來說明。證據等級 LEVEL A (多項隨機控制實驗或綜合分析)，LEVEL B(單一隨機控制實驗或非隨機研究)，LEVEL C(只有專家意見，個案研究，標準照護); 推薦等級 Class I (好處>>>害處),Class IIa(好處>>害處)，Class IIb(好處>=害處)，ClassIII(害處>=好處)。
1. Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from ICH (Class I; Level of Evidence: A). (Unchanged from the previous guideline)(電腦斷層或核磁共振被推薦來區別腦出血或缺血腦中風)。
2. CT angiography and contrast-enhanced CT may be considered to help identify patients at risk for hematoma expansion (Class IIb; Level of Evidence: B), and CT angiography, CT venography, contrast-enhanced CT, contrast-enhanced MRI, magnetic resonance angiography,and magnetic resonance venography can be useful to evaluate for underlying structural lesions,including vascular malformations and tumors when there is clinical or radiological suspicion (Class IIa;Level of Evidence: B). (New recommendation)。 3.Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively.(Class I, Level C)(New recommendation)(病患有嚴重凝血因子缺乏或嚴重血小板缺乏應接受適當地凝血因子或血小板補充充)。 4.Patients with ICH whose INR is elevated due to OAC should have their warfarin withheld, receive therapy to replace vitamin K–dependent factors and correct the INR, and receive intravenous vitamin K.(Class I, Level C)(Revised from the previous guideline)(因口服抗凝血劑導致INR延長應停止warfarin及接受Vitamin k 制劑) 5.PCCs have not shown improved outcome compared with FFP but may have fewer complications compared with FFP and are reasonable to consider as an alternative to FFP (Class IIa; Level of Evidence:B).(Prothrombin complex concentrate對比新鮮冷凍血將有較少的併發症) 6.Until ongoing clinical trials of BP intervention for ICH are completed, physicians must manage BP on the basis of the present incomplete efficacy evidence.Current suggested recommendations for target BP in various situations are listed in Table 6 and may beconsidered (Class IIb; Level of Evidence: C). (Unchanged from the previous guideline)
