大面积脑梗死诊疗指南ppt课件

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1、Evidence-BasedGuidelinesfortheManagementofLargeHemisphericInfarctionThesixthaffiliatedhospitalofKMUWanghao2015.05.21Largehemisphericinfarction(LHI),alsoknownasmalignantmiddlecerebralinfarction,isadevastatingdiseaseassociatedwithsignificantdisabilityandmortality.c

2、urrentstrokeguidelinesdonotprovideadetailedapproachregardingtheday-to-daymanagementofthesecomplicatedpatientsThepurposeofthisguidelineistoprovideevidence-basedrecommendationsforthecriticalcaremanagementofpatientsfollowingLHIAirwayManagementWhataretheindicationsfor

3、intubationandextubationinLHI?•WhatisthebesttimingfortracheostomyinLHI?WhataretheindicationsforintubationandextubationinLHI?1.存在呼吸功能不全或神经功能恶化的LHI患者应该立即气管插管。（强推荐，极低质量证据）。2.即使不能交流和配合，符合以下标准者应该尝试拔管（强推荐，极低质量证据）：（1）自主呼吸试验成功（2）口咽部无分泌物聚集（3）咳嗽反射存在，插管不耐受（4）无镇静和镇痛Whatisthebe

4、sttimingfortracheostomyinLHI?拔管失败或插管后7-14天不能拔管的LHI患者可以考虑气管切开。（弱推荐，低质量证据）。AnalgesiaandSedationsedationandanalgesiamayfacilitatemedicalgoalssuchasloweringICP,enablingproceduresandoperations,orterminatingseizuresShouldanalgesiaand/orsedationbeadministeredinLHIpatient

5、s?Ifso,whichpharmacologicagentsshouldbeused?1.疼痛、焦虑、躁动者推荐给予镇静和镇痛。（强推荐，极低质量证据）2.尽可能给予最低强度的镇静治疗，尽可能尽早停止镇静治疗，同时应保持生理学稳定，防治患者的不适感。（强推荐，极低质量证据）Aredailywake-uptrialsrecommended?Wake-uptrialswereinitiallyreportedtobebeneficialregardingreductionofventilationdurationandout

6、comeforsomeICUpopulations.对于LHI患者，不推荐每天常规进行唤醒试验。存在ICP危象者采取俯卧位通气应谨慎。推荐进行神经功能监测（至少包括ICP和CPP）以指导镇静治疗，生理学不稳定或不舒适的患者每天唤醒试验应避免或者延期执行。（强推荐，极低质量证据）GastrointestinalTractDysphagiaaffects30–50%ofacutestrokepatients.Screeningfordysphagiahasbeenreportedtodecreasepneumoniainthe

7、generalstrokepopulation;Dysphagiascreeningtestssuchastheguggingswallowingscreenhavebeenfoundusefulinacutestrokepatients,butpatientswithlargeormultiplestrokesorrapiddeclineinLOCwerenotincluded.Thus,itisdifficulttoestimatethevalidityofthesetestsinLHIpatientsendoscop

8、icswallowingtests，FiberopticendoscopicevaluationofswallowingHowshoulddysphagiabeassessedinLHIpatients?Theswallowingprovocationtest,endoscopicswallowingt