Stroke Fast Track

Vol.5 No.2 FAQ
Stroke Fast Track
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1
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“¢“ª√– “∑«‘∑¬“ ¿“§«‘™“Õ“¬ÿ√»“ μ√å §≥–·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬¢Õπ·°àπ
Question 1. Stroke fast track ¡’ surgical
complications Õ–‰√∫â“ß
Answer 1. Stroke fast track ¡’ surgical
complications 䴉ᡈ
- Intracerebral hemorrhage
- Hemorrhagic transformation
- Non-communicating hydrocephalus
- Brain herniation
- Brain edema especially malignant
middle artery cerebral infarction
Question 2. Indication for craniectomy
„πºŸâªÉ«¬ stroke ¡’Õ–‰√∫â“ß
Answer 2. Indication for craniectomy
„πºŸâªÉ«¬ stroke ‰¥â·°à
- Malignant middle artery cerebral
infarction ®“° HAMLET study æ∫«à“°“√∑”
early wide decompressive craniectomy
¿“¬„π 45 ™—Ë«‚¡ß ‰¡à«à“®–‡ªìπ ¡Õß´’°„¥°Áμ“¡
‚¥¬‡©æ“–Õ“¬ÿπâÕ¬°«à“ 60 ªï æ∫«à“™à«¬≈¥ mortality rate ®“°√âÕ¬≈– 80 ≈¥≈߇À≈◊Õ√âÕ¬≈– 20
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North-Eastern Thai Journal
of Neuroscience
- Impending brain herniation À√◊Õ
brain herniation ‚¥¬‡©æ“– cerebellar infarction
- Large intracerebral hemorrhage
- Non-communicating hydrocephalus
Question 3. ¬“∑’Ë„™â·°â‰¢¿“«– intracerebral
hemorrhage ®“° rtPA „πºŸâªÉ«¬ cerebral
infarction
Answer 3. ¬“∑’Ë„™â·°â‰¢¿“«– intracerebral
hemorrhage ®“° rtPA „πºŸâªÉ«¬ cerebral
infarction
- ‰¡à¡’ antidote medication ”À√—∫
¿“«–¥—ß°≈à“«
- „Àⷰ≢‚¥¬°“√„Àâ cryoprecipitate 10
units À√◊Õ FFP 4 unit ·≈– platelet concentration 6-8 units
Question 4. ¢âÕ∫àß™’È°“√„™â¬“ nootropic drug
„πºŸâªÉ«¬ stroke
Answer 4. ¬“°≈ÿ¡à nootropic drug ¡’ evidence
based „πºŸâªÉ«¬ stroke ‡æ’¬ß‡≈Á°πâÕ¬ ®÷߉¡à‰¥â
Vol.5 No.2
Õ¬Ÿà „ π·π«∑“ß°“√√— ° …“ºŸâ ªÉ « ¬ stroke ¢Õß
ª√–‡∑»‰∑¬„πªí®®ÿ∫—π
Question 5. ¢âÕ∫àß™’È°“√„™â¬“°—π™—°‡æ◊ËÕªÑÕß°—π
°“√™—°„πºŸâªÉ«¬ stroke
Answer 5. ‰¡à¡’°“√„À⬓°—π™—°‡æ◊ËÕªÑÕß°—π°“√
™—°„πºŸâªÉ«¬ ®–æ‘®“√≥“„Àâ°√≥’∑’˺ŸâªÉ«¬¡’°“√™—°
‡∑à“π—Èπ ‚¥¬„À⬓°—π™—°μ“¡√Ÿª·∫∫°“√™—° ·≈–
‚√§ª√–®”μ—«¢ÕߺŸâªÉ«¬
Question 6. ‚¥¬∑—Ë«‰ª·≈⫺ŸâªÉ«¬ cerebral
infarction æ∫ hemorhagic infarction ∑’ºË ªŸâ «É ¬¡’
deterioration of stroke √âÕ¬≈– 0.6-0.7 ·μà„π
°√≥’ malignant middle artery cerebral
infarction æ∫‰¥â∫àÕ¬‡∑à“„¥
Answer 6. ºŸâªÉ«¬ malignant middle artery
cerebral infarction æ∫ hemorrhagic infarction √âÕ¬≈– 6-7
Question 7. °“√ preserve penumbra zone
„πºŸâªÉ«¬ cerebral infarction ‰¥â·°à
Answer 7. °“√ preserve penumbra zone „π
ºŸâªÉ«¬ cerebral infarction ª√–°Õ∫¥â«¬
- πÕπÀ—« Ÿß 30 Õß»“
- Oxygen therapy ‰¡à „ Àâ ‡ °‘ ¥ ¿“«–
hypoxia
- ≈¥‰¢â ‚¥¬„ÀâÕÿ≥À¿Ÿ¡‘ < 37.5 Õß»“
- §«∫§ÿ¡√–¥—∫πÈ”μ“≈„Àâ¡’§à“√–À«à“ß 140180 mg/dl
- BP < 220/120 mmHg ∂Ⓣ¡à¡’ malignant hypertension
- °“√ª√–‡¡‘π√–¥—∫ “√πÈ”„π√à“ß°“¬„ÀâÕ¬Ÿà
„π¿“«– ¡¥ÿ≈¬å
Question 8. °“√√—°…“ stroke fast track ¡’
§«“¡§ÿ⡧à“À√◊Õ‰¡à ‡æ√“–Õ–‰√
Answer 9. °“√√—°…“ stroke fast track ¡’§«“¡
§ÿâ¡§à“‡æ√“–
1.Decrease morbidity and mortality
2.Improve quality of life
3.≈¥¿“√–°“√¥Ÿ·≈¢Õߧ√Õ∫§√—«·≈– —ߧ¡
≈¥§à“„™â®à“¬„π°“√¥Ÿ·≈ºŸâªÉ«¬
Question 9. °“√„À⧫“¡√Ÿâ·°àª√–™“™π §«√
ª√–°Õ∫¥â«¬
Answer 9. °“√„À⧫“¡√Ÿâ·°àª√–™“™π §«√
ª√–°Õ∫¥â«¬
1. à߇ √‘¡π‚¬∫“¬‡™‘ß√ÿ° „π°“√ª√–‡¡‘π
√—°…“ªÑÕß°—πªí®®—¬‡ ’ˬߢÕß°“√‡°‘¥‚√§
2.„À⧫“¡√Ÿâ§«“¡‡¢â“„®„π‡√◊ËÕßÕ“°“√¢Õß
‚√§„π‡∫◊ÈÕßμâπ
3.Õ∏‘∫“¬·π«∑“ß„π°“√√—°…“·≈– àßμàÕºŸâ
ªÉ«¬„Àâ‡√Á«∑’ Ë ¥ÿ ‡æ◊ÕË √—∫°“√√—°…“ stroke fast track
Õ¬à“ß∑—π∑à«ß∑’
North-Eastern Thai Journal
of Neuroscience
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