急性缺血性卒中静脉溶栓的时间窗与核心排除标准有哪些？
What are the time window and core exclusion criteria for intravenous thrombolysis in acute ischemic stroke?
重组组织型纤溶酶原激活剂静脉溶栓的标准时间窗为发病后4.5小时内，部分经严格影像筛选的患者可延长至6小时。核心排除标准包括颅内出血史、近期大手术或活动性内脏出血、血压持续高于185/110 mmHg未能控制，以及血小板计数过低或正在使用直接口服抗凝药且未超过相应洗脱期。
The standard time window for intravenous rt-PA is within 4.5 hours of symptom onset, extendable to 6 hours in selected patients under strict imaging selection. Core exclusions include prior intracranial hemorrhage, recent major surgery or active visceral bleeding, blood pressure persistently above 185/110 mmHg despite control attempts, and very low platelet counts or direct oral anticoagulant use without an adequate washout interval.
难度 进阶 · 适合 大众
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出处备注：著录含书名，但缺版次 / 出版社 / 年份中的一部分，需编辑补全后才能做独立比对。
中华医学会神经病学分会《中国急性缺血性脑卒中诊治指南2018》 ; 另见: AHA/ASA 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke
AHA/ASA 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke ; see also: 中华医学会神经病学分会《中国急性缺血性脑卒中诊治指南2018》
#神经病学 #缺血性卒中溶栓
突发左侧肢体无力伴言语含糊的患者送达急诊,首选哪种影像学检查区分缺血性与出血性卒中?若确认为急性缺血性卒中,各时间窗内可用的再灌注治疗手段有哪些?
A patient arrives at the emergency department with sudden left-sided weakness and slurred speech. Which imaging study is preferred first to distinguish ischemic from hemorrhagic stroke, and once acute ischemic stroke is confirmed, what reperfusion treatments apply within their respective time windows?
头颅CT平扫是首选初筛手段,脑出血呈高密度灶而超早期脑梗死通常无明显密度改变,因此在实施溶栓前必须先行CT排除出血。确诊缺血性卒中且发病不超过4.5小时者可给予阿替普酶静脉溶栓,合并大血管闭塞的患者在6小时内可行动脉机械取栓,经严格影像筛选的部分患者可延长至24小时。评估过程应同步完成NIHSS评分,并尽早将患者收入卒中单元接受规范化治疗。
Non-contrast head CT is the first-line screen: intracerebral hemorrhage appears hyperdense while hyperacute infarcts typically show no density change, so CT must exclude bleeding before any thrombolysis is given. Confirmed ischemic stroke within 4.5 hours of onset warrants intravenous alteplase, and patients with large-vessel occlusion may undergo mechanical thrombectomy within 6 hours, extendable to 24 hours in selected cases meeting advanced imaging criteria. NIHSS scoring proceeds in parallel throughout evaluation, and prompt admission to a stroke unit initiates standardized care.
难度 进阶 · 适合 初中(12-15)
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出处备注：著录含书名，但缺版次 / 出版社 / 年份中的一部分，需编辑补全后才能做独立比对。
中华医学会神经病学分会脑血管病学组《中国急性缺血性脑卒中诊治指南2018》,中华神经科杂志2018年第51卷第9期
Cerebrovascular Disease Group of Chinese Society of Neurology, Chinese guideline for diagnosis and treatment of acute ischemic stroke 2018, Chinese Journal of Neurology 2018;51(9):666-682
#神经病学 #急性脑血管病救治
家人突然口角歪斜、一侧手臂抬不起来、说话含糊不清,此刻应当立即做什么?为什么不建议先在家观察或自行服药?
If a family member suddenly shows facial droop, cannot lift one arm, and slurs their speech, what should be done immediately—and why is waiting at home or self-medicating discouraged?
这三个体征恰好对应FAST识别法,高度提示急性脑卒中,应立刻呼叫急救并送往具备卒中救治能力的医院。静脉溶栓一般要求发病4.5小时内给药,取栓时间窗亦有限,而每延误一分钟约有190万个神经元死亡。居家观望会直接错过再灌注时机,擅自服用降压药或阿司匹林则可能掩盖病情,若是出血性卒中反而加重出血。
These three findings map exactly onto the FAST screen and strongly indicate acute stroke, so call emergency services at once for transport to a stroke-capable hospital. Intravenous thrombolysis must usually start within 4.5 hours of onset, endovascular thrombectomy windows are likewise finite, and roughly 1.9 million neurons are lost every minute of delay. Watching at home squanders the reperfusion window, while unprescribed antihypertensives or aspirin can muddy the picture—or aggravate bleeding if the stroke proves hemorrhagic.
难度 进阶 · 适合 大众
CC BY 4.0 · 来源待核验 · Source pending review
来源 · Source
出处备注：著录含书名，但缺版次 / 出版社 / 年份中的一部分，需编辑补全后才能做独立比对。
美国心脏协会/美国卒中协会《急性缺血性卒中早期管理指南》2019年
AHA/ASA Guideline for the Early Management of Patients With Acute Ischemic Stroke, 2019
#脑卒中 #急救识别