Ext.?????? ?.??????? Ext.???? ??????? Ext.????? ??????????

1
Ext.?????? ?.??????? Ext.???? ???????Ext.?????
??????????

• Stroke in Soidao

2
????????????????
3
????????????????

• Every two seconds,
• someone in the world suffers a strokeEvery six
  seconds,
• someone dies of a strokeEvery six seconds,
• someones quality of life will forever be
  changed they will permanently be physically
  disabled due to stroke

4
????????????????

• ?????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ?? ??????????????????????????????????????????????
  ?.?. 2551 ???????????????????????????????????
  257/100,000 ???????????? 980/100,000 ??
  ?????????????? 1,629 ????????? ?????????
  257/100,000 ??(446/???) ?????????????? 29,571
  ????????? ???????????????? 2,973 ????????????
  ??????????????????????????????????? 0.5
  ?????????????????????????????? 20,632
  ???????????? ??????? ?.?. 2552 ???????????????????
  ?????????????21/100,000

5
??????????????????????????????????????????????Dis
ability Adjusted Life Years (DALYs)
????????????? ?.?. 2542 (??????)

• ??? DALYs ??????
• 1. ????? 960,086 17
• 2. ??????????????? 510,909 9
• 3. ????????????? 271,009 5
• 4. ????????? 248,083 4
• 5. ??????? 168,594 3
• 6. ??????????????????????? 159,188 3
• 7. ??????????????? 156,861 3
• 8. ??????????/????????? 156,853 3
• 9. ?????????/???????????? 147,988 3
• 10. ???????? 137,703 2
• ????? Burden of disease and injuries in
  Thailand Minstry of Public Health Nov 2002
• (http//203 157.19.191/index-burden.htm)

6
??????????????????????????????????????????????
DALYs ????????????? ?.?. 2542 (???????)

• ??? DALYs ??????
• 1. ????? 372,956 10
• 2. ????????????? 282,509 7
• 3.. ??????? 267,155 7
• 4. ??????????? 145?336 4
• 5. ????????? 118,384 3
• 6. ????????????? 117,994 3
• 7. ????????(????????????) 112,990 3
• 8. ??????????????? 108,449 3
• 9. ??????????????????????? 102,863 3
• 10. ???????? 96,091 2
• ????? Burden of disease and injuries in
  Thailand Minstry of Public Health Nov 2002
• (http//203 157.19.191/index-burden.htm)

7
The top killers in Thailand 1999 (Male)

• Diseases Deaths
• 1. HIVAIDS 40,064 18
• 2. Traffic accidents 21,901 10
• 3. Stroke 18,286 8
• 4. Liver cancer 13,774 6
• 5. COPD 10,977 5
• 6. Ischemic heart disease 9,734 4
• 7. Homicide/Violence 6,786 3
• 8. Suicides 6,671 3
• 9. Lung cancer 6,461 3
• 10. Diabetes 6,223 3
• ????? Burden of disease and injuries in
  Thailand Minstry of Public Health Nov 2002
• (http//203 157.19.191/index-burden.htm)

8
Top 10 killers in Thailand 1999 (Female)

• Diseases Deaths
• 1. Stroke 23,433 14
• 2. HIVIAIDS 16,443 10
• 3. Diabetes 12,235 7
• 4. Ischemic heart disease 8,089 5
• 5. Liver cancer 7,938 3
• 6. Lower respiratory tract infection 5,521 3
• 7. Traffic accident 5,330 3
• 8. COPD 5,132 3
• 9. Tuberculosis 4,413 3
• 10. Nephritis Nephrosis 4,123 2
• ????? Burden of disease and injuries in
  Thailand Minstry of Public Health Nov 2002
• (http//203 157.19.191/index-burden.htm)

9
????????????????

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

10
????????????

• ??????????????????????????????????????????????
  ?.????????
• ?????????????????????????????????????????????????,
  ????, ??????????????????????????
• ??????????????????????????????????????????????????
  ????????????

11
????????????

• ??????????????????????????????????????????????????
  ????????????????????(??????? HosXp)
  ?????????????????? ???????????????
  ??????????.?.2553-2556
• ?????????????????? SPSS

12

• ?????????????????????
• ???
• ????
• ??????????????????????? Ischemic, Hemorrhagic,
  Unknown
• ???????????? DM, HT, DLP, Heart disease,
  Smoking
• ????????????

13
????????????????
??. ??. ?????? ???????? ??????????????? ??????????
??? ?????????????????????
14
????????????????
Cerebrovascular disease CVD (CVA) STROKE Brain
Attack
Rapidly developed clinical signs of
focal(global) disturbance of cerebral function
lasting more than 24 hours or leading to death,
with no apparent cause other than a vascular
origin.
15
????? stroke
????????????
16
STROKE ! !

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

17
????????????????
??????????? ???? ?????? STROKE , CEREBROVASCULAR
DISEASE (CVD)
??????????? 2 ???????? 1. ????????????????????
????????? (Ischemic stroke) 2.
??????????????????? (Hemorrhagic stroke)
18
Types of Ischemic Stroke
19
???????????????????
?????????????????????? ??????????????????????????
???????????????????????? ?????????????????????????
?????????????????????????????????????????????????
???????????????????????????
20
??? ?????????????????????????????????????????? ?
21
??????????????????????????????????????

• ??????????????????
• ??????????
• ????????????
• ????????
• ???????
• ???????????????
• ?????????
• ?????????????????
• ?????? (sleep apnea)
• ????

22
Stroke Risk Factors
????????????????? Non-modifiableAge, Gender,
Race, Heredity
?????????????? Modifiable

• Behaviors
• Cigarette smoking
• Alcohol abuse
• Physical inactivity

• Medical Conditions
• Hypertension
• Cardiac disease
• Atrial fibrillation
• Dyslipidemia
• Diabetes mellitus
• Carotid stenosis
• Prior TIA or stroke
• Elevated homocysteine
• Atherosclerosis of aorta

Sacco RL, et al. Stroke 1997281507-1517. Panciol
i AM, et al. JAMA 19982791288-1292.
23
Prevalence of Stroke by Age and Sex
NHANES III 1988-94
p16
Source CDC/NCHS.
24
??????????????????????????????????????
1. ????????????? (Atherosclerosis)
???????????????????????????????? ???????
?????????????? ???????????????????????????
????????????????????? ?????????????????
??????????????????????????, ??????????,
?????????????????? ???? ?????????
25
??????????????????????????????????????
26
?????????????????????????????
27
??????????????????????????????????????
2. ???????? ??????????????????????????????????????
? ??????????????????? ?????????????????????
??????????????????????? 3. ???????????????????
4. ??????????????? 5. ??????????????????????
28
????????????????????????????
1. ?????????????????? 2. ????????????????????????
?????
29
???????????????????
30
????????????????????????

• ?????????????????????!!
• ?????????????????????????
• ??????????
• ?????????? ?????????????
• ????? ???? ??????????????
• ????????? ????????
• ???????? ???????
• ??? ????????????

31
????????????????????????
1669
32
????????????????????????????????????????????? ?
?????????????????????????????????
33
????????????????????.

• 15-20 ?????????
• 20-30 ?????????????????????
• 50 ??????????????????????????????????

34
???????????????????????????????
1. ??????? ??????????? 2. ?????????????????????
?????????????? ????? CBC, Cholesterol, ??????
... ???????????????(EKG) ?????????????? ???
??? Echocardiogram 3. ???????? ?????????
35
???????????????????????????????
??????????? ?????????
1. ???????????????????? (CT scan) 2.
????????????????????????? (MRI, MRA) 3.
???????????????????????????????(Ultrasound) 4.
????????????????????????????????
36
????????????????????????
37
Brain CT scan in Stroke !
Abnormal
Normal
Hypodense
Hyperdense
Ischemic stroke
Hemorrhagic stroke
38
Stroke Fast Track
Consider Thrombolytic Treatment
Onset 3hr CT neg Inclusion Exclusion
39
???????????????????????????
1. ???????????????? ????????????????
thrombolysis Aspirin / ??????????????????????????
?
2. ?????????????? ???????? stroke
unit ???????????? ???????????? ???????????? ??
??????????????????????? ???????????????????????
(220/120 mmHg) 3.????????????????????????????????
???
40
???????????????????????????
1. ??????????????????????????? ????????????? ???
??????
2. ?????????????????????????????????? ???????????
?? Angiogram ?????????
41
????????????????????????

1. ?????????????????????? ???? ????????? ????????
2. ???????????????????? ??????????? ???????????????
3. ???????????????????????????????????

42
???????????????

• 1. ????????????????????
• ??????????????????????????
• ???????????????
• ????????????????????????
• ??????????????????????????????
• 2. ????????????????????????????????????
• 3. ??????????????????? ????????

43
(No Transcript)
44
(No Transcript)
45
(No Transcript)
46
(No Transcript)
47
(No Transcript)
48

• ?????????????????????
• ???
• ????
• ??????????????????????? Ischemic, Hemorrhagic,
  Unknown
• ???????????? DM, HT, DLP, Heart disease,
  Smoking
• ????????????

49
??????????????

• ??????????????????????????????????????????????????
  ???.????????????????.?. 2553-?????? ?.?. 2556
  ??????????????? 384 ??

50
?????????????????????????????????????????????????
51
??????????????????????????????????????????????????
?
52
(No Transcript)
53
?????????????????????????????????????????????????
????????????????????????????????
54
??????????????????????????????????????????????????
???????????
55
?????????????????????????????????????????????????
???????????????????
56
??????????????????????????????????????????????????
???????????????????????????
57
?????????????????????????????????????????????????
????????????????????????????
58
??????????????????????????????????????????????????
?
59
?????????????????

• ??????????????????????????????????????????????????
  ??????????????? 58 ?????????????????
  ??????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ??????????????????????????????

60
?????????????????

• ??????????????????????????????????????????????????
  ???96?????????25?????????????????
  ??????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ???????????????????????????????????
  ??????????????????????????????????????????????????
  ????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ????????????????????????????

61
???????????????????

• ???????HosXp ???????????????????????????????.?.
  2553
• ??????????????????????????????????????????????
  ???? ??????? meningitis, brain tumor, Bells
  palsy ???????
• ??????????????????????????????????
• ????????????????????????????????????
  ?????????????????? ???????????????
• ?????????????????????