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題 名 | 腦中風急性期高血壓之處理=Management of Hypertension in the Acute Stage of Stroke |
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作 者 | 陳獻宗; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 3:2 2001.04[民90.04] |
頁 次 | 頁158-165 |
分類號 | 415.922 |
關鍵詞 | 高血壓; 腦中風; 腦缺血; 腦出血; 急性期; Hypertension; Stroke; Cerebral ischemia; Cerebral hemorrhage; Acute stage; |
語 文 | 中文(Chinese) |
中文摘要 | 腦中風急性期之高血壓要不要治療,要治療到什麼程度,一直存在著爭議。有學者認為血壓持續明顯的上升,會增加腦水腫,會使腦出血持續擴大,因而造成顱內壓上升,然而此種說法迄今尚未被證實。相反的,有更多的證據顯示,動脈壓明顯的降低會危害腦部的血液灌流量,進而導致腦細胞的缺血性傷害。目前為止,尚無資料顯示多少的血壓算太高,何種血壓範圍是最佳的數值,大部份學者都認為除非是由於主動脈剝離所造成的腦中風,或病人的高血壓已瀕臨左心室衰竭的階段,才考慮降低血壓,否則腦中風急性期高血壓之治療還是以保守為宜。至於治療的推薦用藥,首選的是同時具有α和β受體之阻斷劑,例如Labetalol,其次是Angiotensin Converting enzyme Inhibitors (ACEI)或β受體阻斷劑。Sodium nitroprusside雖被推薦使用於高血壓危相(Crisis),然而此藥和其它血管擴張劑會導致顱內壓升高,應只在無顱內血壓增高時才考慮。鈣離子阻斷劑Nimodipine可用於動脈瘤破裂所致之蜘蛛膜下腔出血,然而Nifedipine的舌下含片有導致血壓急速且過度下降之危險,於急性期腦中風宜避免使用。 |
英文摘要 | The management of hypertension in the acute phase of stroke is a controversial issue. No definitive data from controlled clinical trials are available to settle the issue and there are conflicting recommendations. Some researchers have reported that persistent marked elevation of arterial blood pressure can promote bleeding, increase cerebral edema, and raise intracranial pressure. On the other hand, more and more evidences suggest that acute lowering of the blood pressure may cause hypoperfusion of the brain and further ischemic brain injury. Up to date, there is no recognized information regarding the optimal blood pressure range in the acute stage of stroke. Most investigators agree that blood pressure reduction is indicated only for stroke due to aortic dissection, impending cardiac failure, or true hypertensive emergencies. Otherwise, the management of hypertension during acute stage of stroke should be conservative. The usual drugs of choice are combined α and β receptor blockers followed by angiotensin-converting enzyme inhibitors or β receptor blockers. Although sodium nitropusside is recommended in the treatment of hypertensive crisis, this drug and other vasodilating agents may produce an increase in intracranial pressure and should be considered only when there is no evidence of intracranial hypertension. Nimodipine, a calcium antagonist, is useful in the early stage of aneurismal subarachnoid hemorrhage. However, nifedipine, another calcium antagonist, may cause rapid drop of blood pressure and is better be avoided during acute phase of stroke. |
本系統中英文摘要資訊取自各篇刊載內容。