Interpretation（No.2） of Stroke and Transient Ischaemic Attack in Over 16s：Diagnosis and Initial Management

doi:10.12114/j.issn.1007-9572.2020.00.473

Abstract

Abstract: The NICE clinical guideline CG68（July 2008），Stroke and Transient Ischaemic Attack in Over 16s：Diagnosis and Initial Management，has been updated and superseded by NG128（May 2019） for there are new developments in stroke treatments，such as newly emerging evidence related to blood pressure control for people with acute intracerebral haemorrhage，decompressive hemicraniectomy，optimal positioning and early mobilisation for people with acute stroke，and so on，and for supplementing the existing suggestions on the diagnosis and acute management of confirmed or suspected transient ischaemic attack（TIA） or acute stage of a stroke in the 48 hours after onset of symptoms as the best clinical advice. The guideline includes 9 recommendations，among which the 1.1.1-1.4.8 recommendations，including rapid recognition of symptoms and diagnosis，imaging for people with suspected TIA or acute non-disabling stroke，specialist care for people with acute stroke，thrombolysis and thrombectomy for people with acute ischaemic stroke have been interpreted in our previous study，and the 1.4.9-1.9.7 recommendations，are interpreted here in the light of relevant research progress，mainly covering aspirin and anticoagulant treatment，decompressive hemicraniectomy for people with acute stroke，blood pressure and blood sugar control，nutrition and rehabilitation management. Our interpretation may provide a reference for domestic clinical practice of care involving mainly emergency and neurology for improving the clinical curative effect.

Key words: Stroke；Ischemic attack, transient；Guidelines；Interpretation

摘要： 英国国家卫生与临床优化研究所（NICE）于2008年7月发布了《急性卒中和短暂性脑缺血发作的诊断和最初管理》指南，但卒中的治疗方法发生了变化，在急性出血性卒中血压管理、去骨瓣减压术实施、卒中后最佳体位和早期活动等方面出现了新的证据。所以，NICE在2019年5月又公布了新版《大于16岁人群卒中和短暂性脑缺血发作的诊断和初期管理指南》，以补充阐释上述问题，为短暂性脑缺血发作（疑诊或确诊）和脑卒中急性发作后48 h内的诊断和治疗提供最佳临床建议。NICE指南共有9条推荐意见，研究组前期发表的指南解读（一）对其中的“1.1.1~1.4.8条”推荐意见进行了阐释，内容包括快速识别和诊断、疑诊短暂性脑缺血发作或急性非致残性卒中的影像学检查、急性卒中的专科处理、急性卒中溶栓和血栓清除术。本文则结合相关研究进展对其中的“1.4.9~1.9.7条”推荐意见进行解读，内容包括抗血小板和抗凝治疗、去骨瓣减压治疗、血压和血糖管理、营养管理、运动康复管理等。本文通过对该指南的解读，可以为我国急诊科、神经科等临床科室的实践工作提供参考，优化临床疗效。

关键词: 卒中；脑缺血发作, 短暂性；指南；解读

LI Zhenghuan,CHEN Yang,SONG Xueli, et al. Interpretation（No.2） of Stroke and Transient Ischaemic Attack in Over 16s：Diagnosis and Initial Management 　[J]. Chinese General Practice, 2021, 24(7): 775-779. DOI: 10.12114/j.issn.1007-9572.2020.00.473.
李正欢,陈杨,宋雪利等. 2019年NICE《大于16岁人群卒中和短暂性脑缺血发作的诊断和初期管理指南》解读（二）[J]. 中国全科医学, 2021, 24(7): 775-779. DOI: 10.12114/j.issn.1007-9572.2020.00.473.

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[2]	LI Zhenghuan，SONG Xueli，LIU Xin，WANG Fei，CHEN Yang. Interpretation of 2019 Stroke and Transient Ischaemic Attack in over 16s：Diagnosis and Initial Management from the National Institute for Health and Care Excellence（1）　 [J]. Chinese General Practice, 2020, 23(16): 1972-1976.