本页汇编了我们与卒中概述有关的内容。有关诊断和治疗的更多信息,请按照下方链接参阅我们关于相关疾病和症状的 BMJ Best Practice 临床实践完整专题。
简介
脑卒中是指一种由脑血管病因学引起的急性神经系统功能障碍,持续时间超过 24 小时。可细分为缺血性脑卒中(由血管阻塞或狭窄引起)和出血性脑卒中(由血管破裂引起,导致脑实质内、蛛网膜下腔和/或脑室内出血)。缺血性脑卒中占所有脑卒中病例的 87%,出血性脑卒中占 10%,蛛网膜下腔出血占 3%。[1]Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation. 2023 Feb 21;147(8):e93-621. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001123 http://www.ncbi.nlm.nih.gov/pubmed/36695182?tool=bestpractice.com
相关疾病
疾病 | 描述 |
---|---|
缺血性卒中 | 无论具体病因如何,当脑血管供血区域的血液供应由于某条脑动脉阻塞或重度狭窄而显著减少时,就可发生缺血性脑卒中。少数缺血性脑卒中由脑窦或皮质静脉血栓形成引起。与缺血性脑卒中密切相关的危险因素包括:高龄、短暂性脑缺血发作史、既往缺血性脑卒中、脑卒中家族史、高血压、吸烟、糖尿病,心房颤动、合并心脏病、颈动脉狭窄、镰状细胞病和血脂异常。[2]Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics, and prevention. Circ Res. 2017 Feb 3;120(3):472-95. https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.116.308398 http://www.ncbi.nlm.nih.gov/pubmed/28154098?tool=bestpractice.com |
颈动脉狭窄 | 少数缺血性卒中的原因。颈动脉的动脉粥样硬化斑块是最常见的病因。斑块破裂后形成栓子,导致颅内动脉栓塞是卒中最常见的机制。 高危险因素包括高龄、吸烟和心血管疾病家族史。[3]de Weerd M, Greving JP, de Jong AW, et al. Prevalence of asymptomatic carotid artery stenosis according to age and sex: systematic review and metaregression analysis. Stroke. 2009 Apr;40(4):1105-13. https://www.ahajournals.org/doi/10.1161/STROKEAHA.108.532218 http://www.ncbi.nlm.nih.gov/pubmed/19246704?tool=bestpractice.com [4]Mathiesen EB, Joakimsen O, Bønaa KH. Prevalence of and risk factors associated with carotid artery stenosis: the Tromsø Study. Cerebrovasc Dis. 2001;12(1):44-51. http://www.ncbi.nlm.nih.gov/pubmed/11435679?tool=bestpractice.com [5]House AK, Bell R, House J, et al. Asymptomatic carotid artery stenosis associated with peripheral vascular disease: a prospective study. Cardiovasc Surg. 1999 Jan;7(1):44-9. http://www.ncbi.nlm.nih.gov/pubmed/10073759?tool=bestpractice.com 对近期中度或高度症状性颈动脉狭窄行颈动脉血运重建术可预防将来发生脑卒中。对无症状狭窄患者行血运重建术的益处尚不确定。 |
短暂性脑缺血发作 | 如果患者出现突发的局灶性神经功能缺损且自行消退、无法用其他疾病(例如低血糖)解释,应怀疑短暂性脑缺血发作(transient ischaemic attack, TIA)。TIA 发生早期复发性脑缺血事件的风险相当大。[6]Amarenco P, Lavallée PC, Labreuche J, et al. One-year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med. 2016 Apr 21;374(16):1533-42. https://www.nejm.org/doi/10.1056/NEJMoa1412981 http://www.ncbi.nlm.nih.gov/pubmed/27096581?tool=bestpractice.com TIA 的高危因素包括心房颤动、心脏瓣膜病、颈动脉狭窄、颅内狭窄、充血性心力衰竭、高血压、高脂血症、糖尿病、吸烟、酒精使用障碍和高龄。[7]Whisnant JP, Brown RD, Petty GW, et al. Comparisons of population-based models of risk factors for TIA and ischemic stroke. Neurology. 1999 Aug 11;53(3):532-6. http://www.ncbi.nlm.nih.gov/pubmed/10449116?tool=bestpractice.com [8]Sacco RL. Risk factors for TIA and TIA as a risk factor for stroke. Neurology. 2004 Apr 27;62(8 Suppl 6):S7-11. http://www.ncbi.nlm.nih.gov/pubmed/15111649?tool=bestpractice.com [9]Bots ML, van der Wilk EC, Koudstaal PJ, et al. Transient neurological attacks in the general population. Prevalence, risk factors, and clinical relevance. Stroke. 1997 Apr;28(4):768-73. https://www.ahajournals.org/doi/10.1161/01.str.28.4.768 http://www.ncbi.nlm.nih.gov/pubmed/9099194?tool=bestpractice.com [10]Larsson SC, Wallin A, Wolk A, et al. Differing association of alcohol consumption with different stroke types: a systematic review and meta-analysis. BMC Med. 2016 Nov 24;14(1):178. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0721-4 http://www.ncbi.nlm.nih.gov/pubmed/27881167?tool=bestpractice.com [11]Woo D, Gebel J, Miller R, et al. Incidence rates of first-ever ischemic stroke subtypes among blacks: a population-based study. Stroke. 1999 Dec;30(12):2517-22. https://www.ahajournals.org/doi/10.1161/01.str.30.12.2517 http://www.ncbi.nlm.nih.gov/pubmed/10582971?tool=bestpractice.com [12]Shinton R, Beevers G. Meta-analysis of relation between cigarette smoking and stroke. BMJ. 1989 Mar 25;298(6676):789-94. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1836102 http://www.ncbi.nlm.nih.gov/pubmed/2496858?tool=bestpractice.com [13]Hillbom M, Saloheimo P, Juvela S. Alcohol consumption, blood pressure, and the risk of stroke. Curr Hypertens Rep. 2011 Jun;13(3):208-13. http://www.ncbi.nlm.nih.gov/pubmed/21327566?tool=bestpractice.com 应尽快进行评估并启动二级预防。 |
出血性卒中 | 脑出血是由血管破裂伴出血进入脑实质所致,从而导致脑组织原发性机械损伤。2020 年,脑出血(intracerebral haemorrhage, ICH)的全球患病人数为 1888 万。[14]GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020 Oct 17;396(10258):1204-22. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30925-9/fulltext http://www.ncbi.nlm.nih.gov/pubmed/33069326?tool=bestpractice.com 高危因素包括高血压、高龄、ICH 家族史、血友病、淀粉样脑血管病、抗凝治疗、使用非法拟交感神经药物、血管畸形和烟雾综合征。[15]Kannel WB, Wolf PA, Verter J, et al. Epidemiologic assessment of the role of blood pressure in stroke. The Framingham study. JAMA. 1970 Oct 12;214(2):301-10. http://www.ncbi.nlm.nih.gov/pubmed/5469068?tool=bestpractice.com [16]Woo D, Sauerbeck LR, Kissela BM, et al. Genetic and environmental risk factors for intracerebral hemorrhage: preliminary results of a population-based study. Stroke. 2002 May;33(5):1190-5. http://www.ncbi.nlm.nih.gov/pubmed/11988589?tool=bestpractice.com [17]Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002 Jan 12;324(7329):71-86. [Erratum in: BMJ 2002 Jan 19;324(7330):141.] https://www.bmj.com/content/324/7329/71.long http://www.ncbi.nlm.nih.gov/pubmed/11786451?tool=bestpractice.com [18]Hart RG, Boop BS, Anderson DC. Oral anticoagulants and intracranial hemorrhage. Facts and hypotheses. Stroke. 1995 Aug;26(8):1471-7. https://www.ahajournals.org/doi/full/10.1161/01.str.26.8.1471 http://www.ncbi.nlm.nih.gov/pubmed/7631356?tool=bestpractice.com [19]Wojak JC, Flamm ES. Intracranial hemorrhage and cocaine use. Stroke. 1987 Jul-Aug;18(4):712-5. http://www.ncbi.nlm.nih.gov/pubmed/3603597?tool=bestpractice.com [20]Barnes B, Cawley CM, Barrow DL. Intracerebral hemorrhage secondary to vascular lesions. Neurosurg Clin N Am. 2002 Jul;13(3):289-97. http://www.ncbi.nlm.nih.gov/pubmed/12486919?tool=bestpractice.com [21]Takahashi JC, Funaki T, Houkin K, et al; JAM Trial Investigators. Significance of the hemorrhagic site for recurrent bleeding: prespecified analysis in the Japan Adult Moyamoya trial. Stroke. 2016 Jan;47(1):37-43. https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.115.010819 http://www.ncbi.nlm.nih.gov/pubmed/26645256?tool=bestpractice.com [22]Dastur CK, Yu W. Current management of spontaneous intracerebral haemorrhage. Stroke Vasc Neurol. 2017 Mar;2(1):21-9. https://svn.bmj.com/content/2/1/21.long http://www.ncbi.nlm.nih.gov/pubmed/28959487?tool=bestpractice.com |
脑动脉瘤 | 血管破裂导致蛛网膜下腔出血前,通常无症状。建议对危险人群进行无创神经血管成像筛查。强危险因素包括吸烟、中高水平酒精摄入、家族史、既往蛛网膜下腔出血和遗传性结缔组织病。[23]Juvela S, Hillbom M, Numminen H, et al. Cigarette smoking and alcohol consumption as risk factors for aneurysmal subarachnoid hemorrhage. Stroke. 1993 May;24(5):639-46. http://www.ncbi.nlm.nih.gov/pubmed/8488517?tool=bestpractice.com [24]Schievink WI. Intracranial aneurysms. N Engl J Med. 1997 Jan 2;336(1):28-40. [Erratum in: N Engl J Med 1997 Apr 24;336(17):1267.] http://www.ncbi.nlm.nih.gov/pubmed/8970938?tool=bestpractice.com |
蛛网膜下腔出血 | 为一种医学急症,即出血进入蛛网膜下腔空间。非创伤性蛛网膜下腔出血最常见原因为颅内动脉瘤。[25]Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006 Jan 26;354(4):387-96.高危因素包括高血压、吸烟、家族史和常染色体显性遗传型多囊肾病。[26]Rinkel GJ. Intracranial aneurysm screening: indications and advice for practice. Lancet Neurol. 2005 Feb;4(2):122-8. http://www.ncbi.nlm.nih.gov/pubmed/15664544?tool=bestpractice.com [27]Etminan N, Chang HS, Hackenberg K, et al. Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis. JAMA Neurol. 2019 May 1;76(5):588-97. https://jamanetwork.com/journals/jamaneurology/fullarticle/2722652 http://www.ncbi.nlm.nih.gov/pubmed/30659573?tool=bestpractice.com [28]Zuurbier CCM, Bourcier R, Constant Dit Beaufils P, et al. Number of affected relatives, age, smoking, and hypertension prediction score for intracranial aneurysms in persons with a family history for subarachnoid hemorrhage. Stroke. 2022 May;53(5):1645-50. https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.121.034612 http://www.ncbi.nlm.nih.gov/pubmed/35144487?tool=bestpractice.com |
撰稿人
作者
Editorial Team
BMJ Publishing Group
利益声明
This overview has been compiled using the information in existing sub-topics.
患者教育信息
血栓引发卒中:预防再次卒中
卒中:治疗
更多 患者教育信息- 登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明