Hemorrhage ea Intracerebral, Stroke e Tsoang Mali ho Li-Thinners tsa Mali, le Reversal Triage¶

Spontaneous intracerebral hemorrhage (ICH) ke ts'ohanyetso ea methapo ea kutlo e matla le ea methapo moo mothapo o hatelletsoeng o phatlohang ka kotloloho ka har'a lisele tsa boko (parenchyma), e tšelang mali ka har'a thipa e thata ea lehata. Le hoja liropo tsa mali a mali li etsa hoo e ka bang karolo ea 15 ho ea ho 20 lekholong ea lichapo tsohle, li baka hoo e batlang e le halofo ea lefu la stroke 'me li ba le keketseho e potlakileng, e kotsi nakong ea 1 ea pele ho lihora tsa 3 ka mor'a ho qala. Haeba motho a e-ba le matšoao a tšohanyetso a methapo ea kutlo (ho opa ha sefahleho, ho fokola ha letsoho, kapa ho lahleheloa ke puo) a tsamaeang le hlooho e bohloko, ho hlatsa, khatello e phahameng ea mali e kotsi, kapa ho falimeha ho ntseng ho fokotseha ka potlako, letsetsa sebaka sa heno. dinomoro tsa tshohanyetso hanghang. Ha u ntse u emetse baoki ba fanang ka thuso ea bongaka maemong a tšohanyetso, hlahloba liprothokholo tsa maemo a tšohanyetso tse amanang temoho ea stroke (FAST), subarachnoid hemorrhage le hlooho ea sealuma, le anticoagulant reversal le mathata a ho tsoa mali.

Hobane mililithara e 'ngoe le e' ngoe ea mali a phonyohang bokong e silakanya li-neurone tse limilione 'me e tsamaisa khatello ea kelello ho lebisa ho lefu la kelello le bolaeang, ho pholoha ha prehospital ho itšetlehile ka lintlha tse tharo tse tiileng: ** le ka mohla u se ke ua fana ka aspirin kapa mali leha e le afe pele ho CT scan ea sepetlele, ho sireletsa tsela ea moea ho tloha ho hlatsa ha u ntse u phahamisa hlooho ea li-paramedics hang-hang, ho fana ka li-paramedics tsa 30 hang-hang. le nako ea ho qetela ea li-anticoagulant ** (warfarin, apixaban, rivaroxaban, edoxaban, kapa dabigatran) kahoo li-antidotes tse khutlisetsang methapo li ka lokisoa pele ambulense e fihla.

Etsa sena hona joale¶

1. Letsa nomoro ea hau ea tšohanyetso ea sebakeng sa heno hang-hang 'me u kenye Temoso ea Stroke. Letsetsa 911 United States le Canada, 112 ho pholletsa le European Union, 999 United Kingdom, 000 Australia, kapa sheba bukana ea rona ea dinomoro tsa tshohanyetso. Bolella motho ea romelang molaetsa ka ho hlaka: *"Ho belaelloa hore ke lefu la ho tsoa mali: ho shoa litho ka tšohanyetso le puo e sa hlakang ka hlooho le ho hlatsa."
2. ** LE KA mohla u se ke ua fana ka aspirin, clopidogrel, ibuprofen, kapa ntho leha e le efe e eketsehileng e fokotsang mali. Ho fana le tekanyo e le 'ngoe feela ea aspirin ho mokuli ea nang le mali a tsoang ka intracerebral ho thibela liplatelete tsa mali ka ho sa feleng 'me ho potlakisa ho ata ha hematoma e bolaeang ka har'a boko.
3. ** Hlalosa motho e mong le e mong ea tšesaane ea mali (anticoagulant kapa antiplatelet) eo mokuli a e nkang le nako e nepahetseng ea oache ea tekanyo ea ho qetela.** Sheba libotlolo tsa lipilisi kapa lipetja tsa tlhokomeliso ea bongaka bakeng sa warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto), ** edoxaysaxi Litaxi*** (Sasavaana) (Pradaxa), enoxaparin (Lovenox/Clexane), kapa clopidogrel (Plavix). E-ba le baoki ba fanang ka thuso ea bongaka maemong a tšohanyetso seea-le-moea lebitso le nepahetseng la lithethefatsi le hora ea tekanyetso ea ho qetela sepetleleng se amoheloang pele ba fihla e le hore k'hemisteng e ka kopanya antidote e thibelang mali ka methapo (4-Factor Prothrombin Complex Concentrate [4F-PCC], Andexanet alfa, kapa Idarucizumab) bakeng sa infusion ea hang-hang") (Code infusion).
4. ** Beha mokuli ka hlooho le 'mele o ka holimo o phahamiselitse likhato tse 30, ho boloka molala o otlolohile bohareng ba moeli (kapa o thellela ka lehlakoreng la bona ha a hlatsa kapa a sa tsebe letho).** Haeba motho a tsohile 'me a sireletsa tsela ea hae ea moea, a phahamisa hlooho le mahetla holimo 30-degree angle hlooho e shebile ka ho toba (e sa sothoe ka lehlakoreng le leng le le leng) ho tsoa lehata le ho theola khatello ea kelello. Leha ho le joalo, haeba motho a qala ho hlatsa kapa a lahleheloa ke kelello, li phutholle hang-hang ho lateral recovery position lehlakoreng la hae e le hore mahlatsa a se ke a huleloa matšoafong.
5. Sheba khafe ea hae ea khatello ea mali haeba e fumaneha hang-hang, empa LE KA mohla u fane ka lipilisi tse eketsehileng tsa khatello ea mali ka tlas'a leleme kapa ka molomo. Bolella baoki ba thuso ea bongaka maemong a tšohanyetso hore na khatello ea mali e baloa joang. Le hoja khatello ea mali ea systolic hangata e phahama ka holimo ho 180 ho ea ho 220 mmHg nakong ea boko bo tsoa mali, ho metsa lipilisi tsa khatello ea mali ea lapeng ho baka kotsi e kotsi ea ho khangoa ho mokuli oa stroke 'me ho baka kotsi e sa laoleheng, e sa tloaelehang ea khatello ea boko. Lingaka tsa boemo ba tšohanyetso le lingaka tsa tšohanyetso li sebelisa li-infusions tse nkang nako e khuts'oane ka mokhoa o nepahetseng (joalo ka nicardipine, clevidipine, kapa labetalol) ho theola khatello ea mali ea systolic hantle ho fihlela sepheo sa 130 ho isa ho 150 mmHg.
6. U se ke ua bua letho ka mokuli (ho se na letho le jeoang, le nooang, kapa la ho koenya) 'me u hlokomele nako ea "Ho Tseba Hantle ho Qetela". U se ke ua fana ka metsi, lero kapa meriana e nooang. Ngola matšoao a motsotso oo hantle a qalileng (kapa lekhetlo la ho qetela ha motho a bonoa a tloaelehile).

Sefate sa ho etsa qeto: ho otloa ke lefu le matla le ho belaelloang hore ho na le mali a tsoang ka hare ho boko kapa tšebeliso e fokolang ea mali¶

flowchart TD
    Start["Khaello ea Tšohanyetso ea Neurological (POTLAKO: Ho Thetheha Sefahlehong, Bofokoli ba Letsoho, Ho Lahleheloa ke Puo) KAPA Ho opa ha Hlooho habohloko, ho hlatsa, Pherekano, kapa Coma."] --> CallEMS["1. Letsetsa Litšebeletso tsa Tšohanyetso (911 / 112 / 999) Hang-hang: Kenya Tlhokomeliso ea Stroke"]

    CallEMS --> NoAspirin["2. MOLAO O MELAO: Le ka mohla u se ke ua Fana ka Aspirin, Ibuprofen, kapa Meriana efe kapa efe ea Molomo."]

    NoAspirin --> AirwayCheck{"3. Na mokuli oa hlatsa, oa rotha, kapa oa otsela kapa oa akheha?"}

    AirwayCheck -->|"EE: Ho hlatsa kapa ho Fokotsa Kelello (GCS tlas'a 9)"| Recovery["Phehella Hang-hang ho ea Boemong ba ho Khutlisa Lateral (Hlooho e Tšehetsoe): Molomo o hlakileng oa mahlatsa, lokolla molala, hlokomela phefumoloho haufi-ufi bakeng sa Cushing triad."]

    AirwayCheck -->|"CHE: Tsoha, u falimehe, 'me u se ke ua nyekeloa ke pelo"| Elevate30["Phahamisa Hlooho le Karolo e ka Holimo ea Torso 30 Degrees: Boloka hlooho le molala li otlolohile bohareng ba mohala (u se ke ua kink methapo ea jugular)"]

    Recovery --> BloodThinner{"4. Na mokuli o noa TSOHLE ea lengolo la ngaka le fokotsang mali (anticoagulant)?"}
    Elevate30 --> BloodThinner

    BloodThinner -->|"E: Warfarin, Apixaban, Rivaroxaban, Edoxaban, Dabigatran, kapa Heparin"| CodeICH["PELE HO ALERT HOSPITAL FOR CODE ICH ANTICOAGULANT REVERSAL: Tlaleha lebitso la sethethefatsi hantle, matla a milligram, le hora e nepahetseng ea tekanyetso ea ho qetela."]

    BloodThinner -->|"CHE kapa ha Tsejoe"| HospitalCT["5. Lipalangoang tse Potlakang ho ea Setsing sa Stroke bakeng sa Hlooho e sa Feleng ea CT: Hlahloba BP, hlahloba tsoekere ea mali ka menoana, boloka NPO ka tieo."]

    CodeICH --> Antidotes["Sephutheloana sa Sepetlele Nakong ea 30 ho Metsotso ea 60 ea ho Fihla Monyako: Warfarin e fumana 4F-PCC + IV Vitamin K; Apixaban / Rivaroxaban e fumana Andexanet alfa kapa 4F-PCC; Dabigatran e fumana Idarucizumab; Smooth IV BP e theolela ho SBP 130-150 mmHg"]

Pathophysiology: kamoo ho tsoa mali ka intracerebral ho hola le ho senya boko¶

Ho fapana le lefu la ischemic (moo leqeba la mali le koalang mothapo oa boko ebe le bolaoa ke tlala ea oksijene ea boko) kapa subarachnoid hemorrhage (moo ho phatloheng ha aneurysm ea saccular sebakeng se tletseng mokelikeli ho pota-pota ka ntle ho boko), intracerebral hemorrhage (ICH) e etsahala ha mothapo o matla o phunyeletsang o phunyeha ** ka ho toba ka har'a ntho e tiileng (parenchyma) ea boko**.

1. Hobaneng ha methapo e tebileng ea boko e phatloha: Charcot-Bouchard microaneurysms le amyloid angiopathy¶

Mafu a mabeli a ikhethileng a bakoang ke methapo ea mali a baka liperesente tse fetang 80 tsa mali a intracerebral a itlelang feela:

• Chronic Hypertensive Microangiopathy (Deep Bleeds): Lilemo tsa khatello e phahameng ea mali e sa laoleheng e otla methapo e menyenyane, e tšesaane e nang le moriri (lenticulostriate, thalamoperforating, le makala a paramedian basilar) e tlohang methapong e meholo e nang le khatello e phahameng e likhutlong tsa 90-degree ho fepa boko bo tebileng. Ha nako e ntse e ea, marako a mesifa ea likepe tsena tse nyenyane haholo a senyeha (lipohyalinosis) le balune ho ba tse fokolang ** Charcot-Bouchard microaneurysms **. Nakong ea ho phahama ka tšohanyetso ha khatello ea mali, e 'ngoe ea lijana tsena tse tebileng e phatloha ka hare ho basal ganglia (putamen), **thalamus **, **cerebellum **, kapa **pons **.
• • Ha likepe tsena tse ka holimo li petsoha, li baka ho tsoa mali a maholo lobar karolong e ka pele, ea parietal, temporal, kapa occipital lobes.

2. Thuto ea Monro-Kellie le mohlala oa avalanche oa katoloso ea hematoma¶

Lehata la motho e moholo ke sekoahelo se tiisitsoeng, se thata sa masapo se nang le molumo o tsitsitseng o ka hare oa hoo e ka bang **1,400 ho isa ho 1,700 milliliters **, e arotsoe ka likarolo tse tharo tse sa tsitsang: mahlaseli a boko (80 lekholong), **cerebrospinal fluid (10 lekholong) *, le ** mali a intravascular (10%) Ho ea ka thuto ea **Monro-Kellie **, hobane lehata ha le khone ho hola, boima leha e le bofe bo bocha bo kentsoeng ka har'a cranium (joaloka letamo le ntseng le eketseha la mali a arterial) le tlameha ho tlosa hang-hang lero la cerebrospinal le mali a venous; hang ha li-buffers tse nyenyane li felile (hangata ka mor'a 50 ho ea ho 80 milliliters ea bophahamo ba hematoma, 'me hanyenyane feela 20 ho 30 milliliters sebakeng se thata sa fossa sa cerebellum), intracranial pressure (ICP) skyrockets exponentially.

Ho hobe le ho feta, intracerebral hemorrhage ha se ketsahalo e le 'ngoe ea motsotsoana. Liphuputso tsa Neuroimaging li bontša hore **katoloso e sebetsang ea hematoma ** e etsahala nakong ea pele 1 ho lihora tse 6 (le ho fihlela lihora tse 24 ho bakuli ba nang le mali a fokolang mali) ka Fisher "avalanche" effect: ha sefofane sa pele sa khatello ea mali se phatloha ka lisele tse bonolo tsa boko, se otlolla le ho kuta likarolo tse ngata tsa microscopic ea trigger e pota-potileng microscopic ea methapo ea bobeli ea mali (e bonahalang ho CT angiograms e le "Spot Sign"). Keketseho e 'ngoe le e' ngoe ea 10 lekholong ea molumo oa hematoma ** e eketsa ka mokhoa o hlakileng monyetla oa lefu kapa kholofalo e matla e sa feleng.

3. Brainstem herniation le Cushing triad¶

Ha lesela le ntseng le eketseha la mali le ho ruruha ho pota-potileng (perihematomal edema) li sutumelletsa hemisphere ea boko e amehileng ka mahlakoreng ho pholletsa le midline (midline shift) le ho theosa ka lesela le moqotetsane le moqotetsane botlaaseng ba lehata (**uncal kapa transtentorial herniation **), boko bo robehile. Sheba matšoao a nyarosang a morao-rao a kliniki a haufi le "brainstem herniation":

1. Seithuti se "pepesitsoeng" (Unilateral mydriasis): Leqeba le atolohang la mali le hatella lobe ea temporal temporal (uncus) khahlano le mothapo oa boraro oa cranial (oculomotor nerve), e leng se etsang hore morutoana o ka ka lehlakoreng le le leng ha boko bo tsoa mali ho atoloha ho bulehile haholo le ho emisa ho honyela ha lebone le khanyetsa.
2. Cushing Triad (Terminal intracranial pressure reflex): Ha khatello e nyolohang ka har'a lehata e hula phallo ea mali ho ea bokong, boko bo baka tsitsipano e matla ea ho qobella mali hloohong, e leng se hlahisang liphetoho tse tharo tsa 'mele:
3. Keketseho e feteletseng ea khatello ea ho otla ha pelo le khatello e phahameng ea mali ea systolic (mohlala, khatello ea mali e tlolela ho 240/90 mmHg).
4. Reflex bradycardia (ho otla ha pelo butle ka tsela e sa tloaelehang, ho theohela ho 40 ho ea ho 50 beats ka motsotso ho sa tsotellehe tlokotsi).
5. Ho hema ka tsela e sa tlwaelehang, ho hema, kapa ho kgefutsa ho hema (Cheyne-Stokes kapa Biot breathing).
6. Khabisa kapa nyenyefatsa boemo: Ho kobeha ho sa tloaelehang ha matsoho ho leba sefubeng (ho khabisa) kapa ho otloloha ho thata le ho potoloha ka hare ha matsoho le maoto ka molala o kobehileng (decerebrate).

E khethollang hemorrhagic stroke (ICH), ischemic stroke, le subarachnoid hemorrhage¶

Le hoja CT scan ea sepetlele e ka arola ka ho feletseng leqeba le tsoang mali ho tsoa ho stroke se koalang, lintlha tse 'maloa tsa kliniki tse ka thōko ho bethe li lebisa ho **intracerebral hemorrhage **' me li u lemosa hore mokuli a ka 'na a senyeha ho ea ho koma ka mor'a metsotso e seng mekae:

Matšoao a ikhethileng a sebaka: libaka tse 5 tsa khale tsa anatomical tsa intracerebral hemorrhage.¶

Lingaka tsa maemo a tšohanyetso le litsebi tsa methapo ea kutlo hangata li ka fumana hore na mothapo o tebileng oa mali o ile oa phatloha pele mokuli a kena CT scanner ka ho sheba ** tsela eo mahlo a shebahalang ka eona ** le hore na 'mele o tsamaea joang:

Anticoagulant-associated intracerebral hemorrhage ("Code ICH" reversal triage)¶

Hoo e ka bang ** 15 ho karolo ea 20 lekholong ea mali a mali a intracerebral ** a etsahala ho bakuli ba nkang lengolo la ngaka ** anticoagulants ea molomo ** bakeng sa fibrillation ea atrial, deep vein thrombosis, pulmonary embolism, kapa mechanical heart valves. Le hoja boko bo itlelang feela bo tsoa mali ho mokuli ea nang le ho koala ho tloaelehileng hangata bo khaotsa ho atoloha ka mor'a lihora tse 3 ho isa ho tse 6, boko bo tsoa mali ka **warfarin, apixaban, rivaroxaban, edoxaban, kapa dabigatran ** bo tsoela pele ho tšollela mali bokong ka **12 ho lihora tsa 24 *, ho jara lefu la 40 ho 60 lekholong ka hare ho 60 lekholong metsotso ea ho fihla sepetlele:

Taolo ea khatello ea mali ho intracerebral hemorrhage: hobaneng ho theola IV ho boloka bophelo¶

Ho feta liperesente tse 75 tsa bakuli ba nang le mali a hlobaetsang a intracerebral ba nang le khatello ea mali ea systolic ka holimo ho 180 ho isa ho 240 mmHg. Le hoja khatello ea systolic e ntse e le holimo joalo, mothapo o robehileng o qobella mali a mangata ka har'a hematoma cavity. Liteko tsa bongaka tse ikhethang (INTERACT2, ATACH-2, le INTERACT3) le 2022 AHA/ASA Guidelines theha melaoana e meraro ea mantlha:

1. Le ka mohla u se ke ua fana ka lipilisi tsa khatello ea mali ka molomo kapa ka lipuo tse ling lapeng: Se ke oa fana ka pilisi e eketsehileng ea home amlodipine, lisinopril, metoprolol, clonidine, kapa sublingual nifedipine. Halofo ea bakuli bohle ba ICH ba na le bothata ba ho metsa (dysphagia) kapa ho hlatsa, ba ipeha kotsing ea ho khangoa kapa ho lakatsa, 'me lipilisi tsa molomo li ka baka ho oa ho sa laoleheng ha khatello ea mali e bolaeang boko ka tlala.
2. Sepehelo sa sepetlele bakeng sa ICH ho tloha ho tse mahareng ho isa ho tse mahareng (e hlahisang SBP 150 ho isa ho 220 mmHg): Lingaka li qala ho rotha ho sa khaotseng, ho nka nako e khuts'oane ka methapo ea methapo ea methapo (nicardipine, clevidipine, labetalol, kapa urapidil ho ea tlase ho hora e le 'ngoe) ho sepheo sa 140 mmHg (sebaka se sireletsehileng sa 130 ho isa ho 150 mmHg)**.
3. Qoba ho theola khatello ea mali ea systolic ka tlase ho 130 mmHg: Teko ea ATACH-2 e pakile hore ho sututsa khatello ea mali ea systolic ka tlase ho 130 mmHg ha ho fokotse ho tsoa mali ho ea pele mme ho eketsa kotsi e mpe ea liphio le cerebral ischemia.

Mohato ka mohato tlhokomelo ea prehospital ha u ntse u emetse ambulense¶

1. ** Ho beha hlooho (30-degree molao khahlanong le boemo ba ho hlaphoheloa): ** Haeba mokuli a falimehile 'me HA A hlatse, phahamisa mokokotlo oa bona o ka holimo' me u nyolohele holimo ** 30-degree incline ** ka ** hlooho le molala li otlolohile ka ho toba bohareng ba bohareng ** 'me u lokolle li-collars tse thata (ho sotha molala ho hula methapo ea ka hare ea jugular le ho phahamisa khatello ea kelello). Haeba mokuli a hlatsa, a ntse a hlatsa, kapa a otsela / a ilibane, li phutholle hang-hang lehlakoreng la hae ho lateral recovery position e le hore mahlatsa a tsoe molomong ka bolokolohi.
2. Thibela ho tsitlella ha Valsalva le ho laola sethoathoa: Boloka phaposi e khutsitse 'me e khutsitse. Ho tsoa mali ha Cortical (lobar) ho etsa hore motho a tšoaroe ka kakaretso qalong ea 8 ho ea ho karolo ea 15 lekholong ea bakuli; ha motho a e-na le sethoathoa, emisa hlooho, u theole motho ka lehlakoreng la hae (bona ho tsieleha thuso ea pele), mme le ka mohla o se ke wa kenya dintho ka hanong.
3. Thibela feberu le ho hlahloba tsoekere ea mali: Nako e 'ngoe le e 'ngoe 1 degree Celsius (1.8 degrees Fahrenheit) ho phahama ha mocheso ho mpefatsa ho ruruha ha boko, kahoo tlosa likobo tse boima. Baoki ba fanang ka thuso ea bongaka maemong a tšohanyetso ba tla lekola tsoekere ea mali hang-hang ho thibela hypoglycemia (<3.3 mmol/L kapa 60 mg/dL).

Lits'ebetso tsa sepetlele tsa neurosurgical le neuro-ICU¶

Hang ha CT scan ea hlooho e se nang phapang e tiisa mali a intracerebral mme e lekanya molumo oa eona (ho sebelisa **ABC/2 formula **: bolelele A bophara ba linako B linako selae botenya C aroloa ka 2), sehlopha sa stroke le neurosurgery se qala **INTERACT3 Sephutheloana sa Tlhokomelo e Lebisoang Lipheo **:

1. Phetoho ea anticoagulant le ho theola khatello ea mali e thellang IV nakong ea metsotso e 30 ho isa ho e 60 ka mor'a ho fihla.
2. External Ventricular Drain (EVD) for intraventricular hemorrhage (IVH): Ha mali a phunyeletsa ka har'a li-ventricle tsa mokelikeli 'me a thibela cerebrospinal fluid drainage (**obstructive hydrocephalus **), lingaka tsa methapo ea kutlo li beha catheter ea ventriculostomy ho ntša metsi le ho shebella khatello ea mali.
3. Ho ntša mali ka ho buuoa: Hang-hang suboccipital craniectomy e pholosa bophelo bakeng sa mali a tsoang cerebellar a fetang limililithara tse 15 (kapa bophara >3 cm), ha endoscopic e hlaselang haholo kapa catheter clot evacuation (teko ea ENRICH) kapa decompressive hemicraniectomy e ka ntlafatsa ho phela maling a maholo a ka holimo a lobar (30 ho isa ho 80 ml).

Linomoro tsa libaka tsa tšohanyetso le liprothokholo tsa mekhatlo¶

Bakuli ba belaelloang ho tsoa mali ka har'a boko ba hloka ho tsamaisoa ka ambulense ka kotloloho ho ea setsing se netefalitsoeng Comprehensive Stroke Center (CSC) kapa sepetlele se nang le CT scanning ea lihora tse 24, anticoagulant reversal antidotes, le neurosurgical/neuro-ICU bokhoni:

• United States le Canada: Letsetsa 911. Bafani ba thuso ea bongaka ba EMS ba sebelisa litekanyo tse matla tsa prehospital (tse kang RACE, LAMS, kapa C-STAT) 'me ba tsebise pele Setsi sa Stroke se amohelang e le hore CT scanner e hlakoloe pele lesela le fihla.
• United Kingdom: Letsetsa 999. Tlas'a NHS le NICE Guideline NG128 (Stroke and Transient Ischemic Attack in Over 16s) le National Stroke Guideline (2023 Edition), bakuli ba ICH ba hlobaetsang ba fumana "ABC Care Bundle" (Potlako Anticoagulant reversal ka hare ho metsotso e 60**loong e tlase ea metsotso e 60*03 khatello e tlase ea B-10. mmHg, le Cke phetiso ea methapo ea kutlo).
• European Union: Letsetsa 112. Latela European Stroke Organization (ESO) tataiso ka ho tlaleha li-anticoagulants tsohle tsa molomo (VKAs kapa DOACs) hang-hang ho romela tšohanyetso.
• Australia le New Zealand: Letsetsa 000 Australia kapa 111 New Zealand. E laoloa tlas'a Stroke Foundation (Australia/NZ) Living Clinical Guidelines for Stroke Management.
• India le Asia-Pacific: Letsetsa 112 (kapa 108 India), 995 Singapore, 119 Japane le Korea Boroa, kapa 999 Malaysia le Hong Kong. Kopa sepalangoang ho ea sepetlele sa thuto e phahameng se nang le CT ea lihora tse 24 le neurosurgery.

Lipotso tse botsoang khafetsa¶

Ke hobane'ng ha ke sa khone ho fana ka aspirin ho motho ea nang le stroke joaloka uena bakeng sa lefu la pelo?¶

Le hoja tlhaselo ea pelo e batla e bakoa ke ho putlama ha platelet ea mali ka har’a mothapo oa pelo, hoo e ka bang karolo ea 15 ho isa ho 20 lekholong ea lichapo tsohle ke liropo tse tšollang mali tse bakoang ke ho phatloha ho tsoang mali ka ho toba bokong. Hobane lichapo tse peli tsa ischemic (clot) le hemorrhagic (ho tsoa mali) li baka matšoao a ts'oanang a tšohanyetso joalo ka sefahleho sa sefahleho, ho holofala ha letsoho, le ho bua hampe, ho ke ke ha khoneha ho ba le bonnete ba 100% lapeng hore na ho etsahala mofuta ofe. Ho fana ka aspirin ho motho ea tšoeroeng ke setorouku se tsoang mali ho thibela ho hoama ha platelet ka ho feletseng 'me ho potlakisa mali a bolaeang ka har'a lehata. Le ka mohla u se ke ua fana ka aspirin ho fihlela CT scan ea sepetlele e paka hore ha ho na mali.

U ka belaela joang hore stroke e ka 'na ea e-ba boko bo tsoang mali ho e-na le ho koala mali?¶

Le hoja e le CT scan ea sepetlele feela e ka pakang hore na o na le lefu lena hakae, ho tsoa mali ka intracerebral ho ka etsahala haholo ha matšoao a tšohanyetso a stroke (bofokoli ka lehlakoreng le leng, ho lahleheloa ke puo, kapa ho lahleheloa ke pono) a tsamaisana le hlooho e bohloko ka tšohanyetso, ho nyekeloa ke pelo le ho hlatsa ho kotsi, khatello e phahameng ea mali (hangata e fetang 180 ho ea ho 220 mmHg), ho tsieleha, ho tsieleha, ho tsieleha kapa ho fokotseha ka potlako. metsotso ea pele e 15 ho isa ho e 60.

Ke hobane'ng ha ho potlakile hakaale ho bolella ba fanang ka thuso ea bongaka maemong a tšohanyetso lebitso le nako ea ho qetela ea motho ea fokotsang mali?¶

Boko bo tsoa mali ho bakuli ba nkang li-thiners tsa mali (warfarin, apixaban, rivaroxaban, edoxaban, kapa dabigatran) li atoloha ka potlako bakeng sa lihora tse 12 ho isa ho tse 24 'me li jara sekhahla sa ho shoa ha 40 ho 60 lekholong ntle le haeba se khutlisetsoa morao hang-hang. Lihlopha tse fapaneng tsa batho ba fokolang mali ba hloka li-antidotes tse fapaneng ka ho feletseng sepetlele (4-Factor PCC le Vitamin K bakeng sa warfarin; Andexanet alfa kapa 4F-PCC bakeng sa apixaban le rivaroxaban; Idarucizumab bakeng sa dabigatran), 'me tekanyo ea Andexanet alfa e itšetlehile ka ho toba ho feta miligram e nyenyane ea ho qetela kapa lihora tse 8 tse fetileng. Ho lemosa sepetlele esale pele ho lumella k'hemisteng ho lokisa moriana pele ambulense e fihla.

Na ke lokela ho fa mokuli oa stroke tekanyo e eketsehileng ea meriana ea hae ea khatello ea mali haeba khatello ea hae ea mali e le 210/110 mmHg?¶

Che, le ka mohla u se ke ua fana ka lipilisi tsa khatello ea mali tsa molomo kapa tsa lipuo tse ling ho motho ea belaelloang hore o na le stroke. Taba ea pele, hangata stroke se holofatsa mesifa ea ’metso e hlokahalang bakeng sa ho koenya ka mokhoa o sireletsehileng, ho baka kotsi ea hang-hang ea ho khangoa kapa ho hema pilisi matšoafong. Ea bobeli, meriana e nooang e theola khatello ea mali ka mokhoa o sa lebelloang 'me e ke ke ea tima haeba khatello ea mali e theoha haholo, e ka bolaeang boko bo ruruhileng ba phallo ea mali. Lingaka tsa sepetlele li theola khatello ea mali hantle ho fihlela sepheo sa 130 ho isa ho 150 mmHg li sebelisa litšelo tse sa khaotseng, tse nkang nako e khuts'oane ka methapo.

Ke hobane'ng ha boko ba cerebellar bo tsoa mali hangata bo sa hlokomeloe e le bothata ba tsebe e ka hare kapa chefo ea lijo?¶

Hobane cerebellum e laola ho leka-lekana le ho tsamaisana ho e-na le matla a letsoho kapa sefahleho, ho tsoa mali ho cerebellar ho baka ho tsekela ka tšohanyetso (vertigo), ho nyekeloa ke pelo ho matla le ho hlatsa, le hlooho e ka morao ea hlooho ntle le ho etsa hore sefahleho se oele kapa ho holofala ha letsoho. Letšoao le khubelu le ka sehloohong le khethollang lefu la cerebellar ho tsoa ho kokoana-hloko ea tsebe e ka hare ke truncal ataxia: mokuli ha a khone ho lula, ho ema, kapa ho tsamaea mohato o le mong ntle le ho oela. Ho amoheloa ha sepetlele pele ho nako ho lumella ho tlosa lesela la ho buoa le pholosang bophelo pele cerebellum e ruruhileng e senya boko ba boko.

Ke hobane'ng ha hlooho ea bethe e lokela ho phahamisoa ka likhato tse 30 ka molala o otlolohileng bokong o tsoa mali?¶

Ho mokuli ea falimehileng ea sa hlatseng, ho phahamisa hlooho le mahetla holimo ka lebelo la 30-degree le hlooho e shebileng pele ka ho toba o sebelisa matla a khoheli ho thusa ho phalla ha mali ka har'a lehata ka methapo ea ka hare ea jugular, e theolang khatello ea kelello ntle le ho fokotsa phallo ea mali bokong. Ho boloka molala o otlolohile ho thibela kinking ea methapo ea jugular. Leha ho le joalo, haeba mokuli a hlatsa kapa a akhehile, ba tlameha ho behoa ka lehlakoreng la bona sebakeng sa ho hlaphoheloa ho sireletsa tsela ea bona ea moea.

Mehloli le tataiso ea semmuso¶

• American Heart Association / American Stroke Association (AHA/ASA, United States): 2022 Tataiso ea Tsamaiso ea Bakuli ba nang le Spontaneous Intracerebral Hemorrhage (Greenberg et al., Stroke, lipheo tsa ho khutlisa anticoagulant, SBP e theolelang ho 130-150 ho kheloha ha plate, ho qoba liplatelete tsa ho buoa, ho qojoa ha methapo ea mali).
• Mokhatlo oa European Stroke Organization (ESO, Europe): Litaelo tsa European Stroke Organization on the Management of Spontaneous Intracerebral Haemorrhage le Anticoagulant-Associated Intracerebral Haemorrhage.
• Setsi sa Naha sa Bophelo bo Botle le Tlhokomelo e Ntle (NICE) & Intercollegiate Stroke Working Party (United Kingdom): Stroke and Transient Ischemic Attack in Over 16s: Diagnosis and Initial Management (NG128) le National Clinical Guideline for Stroke for the UK and Ireland (2023) ("ABC care").
• Bafuputsi ba Teko ea INTERACT3 (Ma L, Hu X, Song L, et al., The Lancet, 2023): The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3).
• ** International Federation of Red Cross le Red Crescent Societies (IFRC) & Komiti ea Australia le New Zealand ea Tsosoloso (ANZCOR): ** Thuso ea Machaba ea Thuso ea Pele, Ho Tsosolosa, le Litaelo tsa Thuto: Tsebiso ea Stroke le Tlhokomelo ea Prehospital.

Litataiso tse amanang¶

• Tlhokomeliso ea stroke (FAST) le thuso ea pele ea hang-hang
• Subarachnoid hemorrhage, thunderclap hlooho, le ho phatloha ha aneurysm ea boko
• Ho tsoa mali ho beha bophelo kotsing ho batho ba fokotsang mali kapa ba nang le hemophilia
• Tlhaselo ea nakoana ea ischemic (TIA / mini-stroke) le kotsi ea stroke ea lihora tse 24
• Mathata a khatello ea mali, khatello ea mali e mpe, le khatello ea mali e fetang 180/120