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Ingen bildrubrik

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... Early Management of Patients With Ischemic Stroke' (American Heart Association) ... (Appraisal of Guidelines Research & Evaluation) ???????? ?? ?????????? ? ... – PowerPoint PPT presentation

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Title: Ingen bildrubrik


1
??????????? ?????? ?????????, ?????????? ???????
????. ????????? ????? ?????????
(medic_at_agidel.ru) ?????????? ???????????
??????????? (???) ????????? ????????? ??????
????? ?? ????????? ????????????? ????????
2
?????????? ? ?????? ?? ?????????
  • ?? 63.5 ?? 100 000
    (??????? ????????? ?????????)
  • ?? 273.4 ?? 100 000 (???????
    ????????? ? ??????)

3
??????????
lt 50 50-74 75-99 100-149 150-199 200-249 gt
250 ??? ??????
??????
????????
???????
???????
??????
???????????
???????
Asplund, 2004
4
???????? ??????????? ??? ?????????
?????????
20
???????
???????
??????
10
????????
0
??? ??????
?????? A????????
-10
???????
-20
1985
1994
1990
Asplund, 2004
Sarti al. Stroke 2000311588
5
????????? 1 ????????
  • ?????????? ? ????????? ??????????? ???????
  • ?? ??????? ? ??????? ???????? ???????? ?? ???
    ?????? ? ??????? 79 000 ???? (??????)

6
?????????? ?? ????????? ? ??????
??????????? ? ????????????? ????????
??????
300
Russia
??????
R
2
0.68
???????
????????
200
??????????
?????????? ?? ?????????
Belarus
Ukraine
.
????????
Mold.
100
??????
Arm.
???????
0
0
10000
20000
30000
??????? ???. ??????? (? ???????? ??? ?? ???.)
Asplund, 2004
7
?-? ?., 72 ???, ??????????? ? 8 ????, ?????????,
??? ? ???? ?? ????????? ?????? ???? ? ???? ?
??????????? ?????????? ????. ??????? ?. ??? ??
??????? ??????? ?????? ??????, ???? ???????
??????????? ??????????? ???????.
  • ???????? ?????
  • ?. ??? ?? ?????? ?/? ????????? ????????
    ???????????????? ?? 5 ?-?? ???????, ?????????
    ?????????? ????? ? ??????????
  • ?. ????? ?????????????????
  • ?. ????? ??????? ???????? ? ?????????????
    ???????????????? ??? ???????????? ???????

8
?-? ?., 72 ???, ??????????? ? 8 ????, ?????????,
??? ? ???? ?? ????????? ?????? ???? ? ???? ?
??????????? ?????????? ????. ??????? ?. ??? ??
??????? ??????? ?????? ??????, ???? ???????
??????????? ??????????? ???????.
  • ???????? ?????
  • ?. ??? ?? ?????? ?/? ????????? ????????
    ???????????????? ?? 5 ?-?? ???????, ?????????
    ?????????? ????? ? ??????????
  • ?. ????? ????????????????? !!!
  • ?. ????? ??????? ???????? ? ?????????????
    ???????????????? ??? ???????????? ???????

9
????????????
  • European Stroke Initiative Recommendations for
    Stroke Management Update 2003
  • Guidelines for Early Management of Patients With
    Ischemic Stroke (American Heart Association)
  • Management of Patients with Stroke A National
    Clinical Guideline recommended for the use in
    Scotland
  • National Clinical Guidelines for Stroke (Royal
    College of Physicians, USA)

10
????????????
  • AGREE instrument
  • (Appraisal of Guidelines Research Evaluation)
  • ???????? ?? ?????????? ? ?????????? ??????????
  • ??????? ? ????????? ????????? ?? ??????? ???? ??
    ?????? ??????????? ????????? ??????????????????
    ?????? ????????????? ??????????????
  • www.osdm.org

11
????????????
  • European Stroke Initiative Recommendations for
    Stroke Management
  • Cerebrovascular Diseases 2004 17(S2) 30-46
  • http//www.eusi-stroke.com
  • ?????? 5-?? ??????????
    ????????? ?? ?????????
    (????????, ??????,
  • 23-26 ???? 2004?.)

12
?????? ?????????????
  • I ?????????
  • ????????? ?????????? ?????????????????
    ??????????? ????????? ? ??????????? ???????????
    ??????????
  • ????-?????? ?????????? ???????????? ????????????

13
?????? ?????????????
  • II ???????
  • ????? ????????????????? ??????????? ?????????
  • ??????????????? ?????????? ???????
    ????????????????? ??????????? ?????????

14
?????? ?????????????
  • III ??????
  • ????????????? ????? ?????????? ?? ?????????? ?
    ???????????? ?????????
  • ????????? ?????? ??????? ?????????????????
    ??????????? ?????????

15
?????? ?????????????
  • IV ??????????????
  • ????????? ????? ???????????? ??? ???????????
    ??????
  • ???????????? ??????, ?? ?????????? ??
    ???????????????

16
????? ?????? ??????? ?? 4 ??????? ????
  • ??????? ????????????? ????????? ?????????
    ????????
  • ??????????? ????? ?????? ?????? (III)
  • ?????????? ????????, ???? ??????? ?????
    ?????????, ? ??????? ??? ??????????????? (I)
  • ???????????? ??????????? ? ??????? ?
    ?????????????????? ?????????? ????? (I)

17
??????????? ??????
  • ????? ????????? ?????????? ?????? (???) ?????????
    ??????????????? ??????? ? 152 ?? 176 ????????? ?
    ????????? (???????????????? 86.4) ? ??????????
    ???????? ? 1818 ?? 1835 ????????? (?????????????
    99.1)
  • Von Arbin M. et al J Chonic Dis.
  • 1980 33215-220

18
(No Transcript)
19
?????? ?????? ??????????? ? ??????????????????
?????????? ????? (I)
  • ???????? ?????? ??????????????????? ????????,
    ?????????? ?????? ? ??????? ???.??????????,
    ????????? ???????? ?????? ? ??????????? ????????
    (I)

20
  • ???????
  • ???????? (?? ???????), 1.5-2 ?/????
  • ??????? (???? ????? gt 12 ?????/?)
  • ?????????????????? (?? ??????????)
  • ??????? (?????? ??? ??????? ????? ?????????????
    ???????? ???)
  • ???????? (???? ?????? ?????????)
  • ???????????? ??? ?????????
  • ??????????? ??? ?????????
  • ??????????? rtPA (?? ??????????)
  • ??????? ? ????????? ??????????? ??????? ???
    ????????? ????????? ?.)

???????
??????
??
???????????? ????????????
????
  • ??????????
  • ???????
  • ?????????
  • ?????? ??????
  • ??????? / ????????
  • ???????
  • ??????? ???????? ???
  • ???????? ????????????? ?????
  • ??????????

?????????? ????????? ? ??????????
  • ????????? ? ????????? ?????????
  • ??????
  • ???????????
  • ?????????
  • ????????????? ???????? ??????????????????
    ???????
  • ????????? ???????????????

Cerebrovasc Dis 1996 6 315-24
21
??????????????? ?????????
  • ???????????? ?????????? ????????? ????? ???
    ?????????????? ????? ?????????????? ? ??????? (I)
  • ??????????? ???????? ?????????? (IV)
  • ???????????? ??????? (???????????, ??),
  • ??????????? ????????? ??????? (???,
    ?????-??????????, ??????? ??????? ??????)
  • ????? ? ????????????? ???????? ?????

22
????????????? ??????????????? ?? ?? ????? ?????
??? ?????????????
23
???????? ???????????? ???????? ????? 8 ????? ??
???????? ?????????? ? ??????
24
??????? ??????? ????????5 ?????????
  • ??????????? ????????? ???????
  • ????????????? ???????, ???????????? ??
    ??????????? ?????
  • ???????????? ? ??????? ??????????
  • ?????? ????????? ????????????
  • ?????? ????????????

25
???????????????
26
???????????????
  • ??? ?????????????? ???????? (NaCl 0.45 ??? 5
    ??????? ???????) ????? ???????? ????? ????? ??-??
    ???????? ???????????? ??????

27
????????
28
????????????? ??????? (??????????? ??????)
  • ??????????? (I) ???
  • ??????? (I)
  • ?????? ??????????? (IV)
  • ??? ??????? ??????? ????????????????
    ?????????? 2 ?? ?/? ??? ???????? (10-20
    ?? ?/?), ????? ???????? ??? ???????????? per os
    (III)

29
????????????? ??????, ??????????????? ????? ???
?????? ??????? ?????????
  • ???????, ????????????????? ???????? ???
    ??????????? ????? ???????????? ???????? (I)
  • ??????????? (I)
  • ??????????????? (I)
  • ???????????????? ???????????????

30
??????????? ?/? (I)
  • ?????????? ?????? ? ??????? ?????? 3 ????? ?????
    ?????? ????????? ????????
  • ?????????????? ???????? ????????? ????????????
    (rtPA Alteplsa)
  • ?????????? ????????? ????? ???????????????
    ??????????
  • ???? 0.9 ??/?? (???????? 90??)
  • ????? ???????? ?/? 10 ???????, ?????????
    ???????? ? ??????? 60 ???.

31
??????????? ?? ? ????? ???????????? (????? ?
???????? ???????)
32
??????? (I)
  • ???? 100 300 ??/???. ? ??????? 48 ?????
  • ??????????????, ???? ??????????? ???????????
  • ?????????????? ? ??????? 24 ????? ?????
    ????????????
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